Blue Cross Offers Prevention And Help Tips As Health Fraud Raises Nationwide | Sponsored: Blue Cross and Blue Shield


When Jimmy Davis presented his Blue Cross and Louisiana Blue Shield card at a healthcare facility prior to a medical procedure, he was stunned by the reaction. Without knowing it, he no longer had a Blue Cross cover.

After a little research, Davis, a member of the Blue Cross Medicare plan, learned that his identity had been stolen. He is not alone. Approximately 2.5 million seniors in the United States fall victim to such crimes each year, said Mike Bertaut, health economist with the Blue Cross.

Davis reached out to his Blue Cross agent, who immediately began working with him and others with the insurer to resolve the issue. She made several personal visits to Davis and steered the paperwork process to ensure his Blue Cross coverage was fully restored and he could get the medical treatment he needed on time.

“I was very proud of the way we handled it,” said Bertaut. “His agent was incredibly caring, empathetic, and smart, like all of our agents here. But it definitely made me realize that there are many people who get into the same situation. “

At Blue Cross, a dedicated fraud department focuses solely on helping people like Davis get the medical care they pay for and need. Kandyce Cowart, special investigation manager at Blue Cross, said there are some common tactics scammers use to try to take advantage of people.

“We often see a sense of urgency,” Cowart said. “They tell people to act now or they will lose. Often times they ask for financial information or money. They say they need money now. It’s about making people feel like they have to do something right away. “

Alice Sibley, an intelligence analyst with the FBI’s New Orleans office, said some scammers could ask for someone’s Medicare or health insurance information, which can create a false sense of security by not asking for direct financial information. However, Sibley noted that even if the person does not divulge their banking information, the consequences could be dire.

“When someone calls and asks for your Medicare or insurance number, they’re trying to make some money,” Sibley said. “If you pay for it, you want to get these benefits. You don’t want someone else to charge you for testing now, and it won’t be available to you when you need it. “

Cowart said many scammers would say they call from a doctor’s office or health insurance company to create a sense of trust and familiarity. If someone receives such an unsolicited call, Cowart said they should quietly hang up and verify the person’s identity before revealing any information.

“Don’t be afraid to be rude,” she said. “If you don’t know the person and they are trying to have a conversation about your health care or finances, it’s okay to hang up or walk away without saying anything.”

Chad Jarrell, an intelligence analyst with the FBI’s New Orleans office, said some programs also offer medical tests or screenings that may be unwarranted.

“People want to stay healthy, especially when they are older. So it’s about making them feel like their health is at risk and that they have to do something if they are to live longer, ”Jarrell said. “Fear is something we see a lot – the fear of missing out if you don’t have this test.”

At the Blue Cross, the protection of members has top priority. The insurer has a dedicated team that deals with fraud, waste and abuse and helps members who report these issues. If a Blue Cross member feels they have fallen victim to a fraud, Cowart said they should call the fraud hotline at 1-800-392-9249 immediately.

At his sister’s house, Jimmy Davis reflects on his experience of identity theft and how Blue Cross has helped him.

“The first thing we try is to learn everything about the conversation, including what the caller asked for and what was made available to them,” Cowart said. “There are phone calls that we can immediately have together on the line to erect blocks. Once we have this information, our next steps will depend on what happened. We usually look for claims and see where we have been billed and the referring doctor, and then work through the paperwork to get the full story. “

Davis worked with Blue Cross to make a video about his story to let others know how to get help. It can be seen here.

Jarrell said fraud can also be reported to the FBI at 1-800-CALL-FBI. The hotline is manned 24 hours a day, seven days a week, and all complaints are documented and dealt with accordingly. You will then be assigned to an FBI agent or analyst for review and investigation.

“Someone will answer and talk to them,” Jarrell said. “If you have provided banking information, you should contact your bank to have your accounts blocked. There are things people can do to limit their exposure, but they have to report it to the appropriate authorities for this to happen. “

Sibley pointed out that Medicare members can also report fraud by calling 1-800-MEDICARE or going online at, which connects to the Federal Trade Commission.

While some people may be embarrassed or afraid to report fraud, Bertaut said it was important to do so to ensure that a person continues to receive the medical treatment he or she needs.

“Nobody will think less of you,” said Bertaut. “If you want to see Blue Cross in action, let us know that your identity has been stolen or someone has changed your plan without your knowledge. Our agents are immediately on these reports and don’t stop until the problem is resolved. “

To become a Blue Cross member or to learn more about how to protect yourself with Blue Cross Medicare plans, please call 1-800-568-1417 (TTY 711) or visit

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