Medicare fraud affects everyone
While the majority of members and health care providers act honestly, there are a small percentage of individuals who take advantage of the system. According to the National Association of Health Care Anti-Fraud Association (NHCAA), an estimated $100 million is lost daily on healthcare fraud.
Blue MedicareRx (PDP) is committed to detecting, correcting and preventing fraud, waste and abuse. The following information is intended to assist you in identifying and reporting suspected cases related to your Blue MedicareRx plan.
What are fraud, waste and abuse
Fraud is an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in an unauthorized benefit to himself/herself or some other person.
Waste is the overutilization of resources, such as ordering testing or medications that you don’t need.
Abuse is any activity that is inconsistent with typical practices that can result in an unnecessary cost to the Medicare program or reimbursement for services that are medically unnecessary or that fail to meet professionally recognized standards for health care.
Don’t worry – you won’t need to decide which of these categories your situation may fall under – just report it to us and we will do the rest.
What you can do to protect yourself
- Always keep all personal information, such as your Medicare number and Social Security number safe
- Never give personal information until you are certain that a person or product is approved by Medicare or Blue MedicareRx. (Contact us if you have any questions.)
- Always review your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). Make sure your EOB does not show prescription drugs you did not receive.
- Don’t accept offers of money or gifts in exchange for providing information about your Medicare prescription drug benefits or Social Security number
- Educate yourself about the Medicare Prescription Drug Program
How to report fraudulent activity to BlueMedicareRx
Contact the Blue MedicareRx Fraud Hotline at 1-888-727-0504 (TTY: 711)Email: ComprehensiveFWA@CVSHealth.com
Please provide as much detail as possible, such as dates, times, names, addresses, and specifics about the alleged fraudulent activity.