What is Health Care Fraud


Health care fraud is "the intentional misrepresentation of a material (important) fact submitted on, or in support of a claim for payment of a health care insurance claim, or the theft of money or property belonging to a health plan or health insurance company.“

  • Not an innocent mistake.
  • Committed by a very small number of people.
  • A serious crime

If you suspect fraudulent activity, please report it immediately.


There are many different kinds of health care fraud. Common examples include:

  • Using an expired or fraudulent identification card to get medical services or medications
  • Lending an ID card to someone who isn't entitled to it
  • Adding someone who isn't eligible for coverage to a contract
  • Providers who bill for services never rendered
  • Performing medically unnecessary services to receive payment from insurers
  • Billing for more expensive services or procedures than were actually provided
  • Accepting kickbacks for patient referrals



How Fraud Impacts You?

For consumers, health care fraud equals higher premiums and out-of-pocket costs, and reduced benefits and coverage. Fraud also hurts employers by driving up the costs of providing benefits to employees and doing business.


Fraud can impact you in the following ways:

  • Health care fraud accounts for approximately 5 -10% of overall healthcare spending, leading to multi-BILLION dollar losses.
  • Fraud carries other implications for victims. You could:
  • Be subjected to unnecessary or unsafe medical procedures or treatments
  • Find that your insurance benefits have unexpectedly been exhausted
  • Have erroneous information added to your medical records
  • Receive the wrong medical treatment
  • Unexpectedly fail a physical examination for employment
  • Be deemed uninsurable as a result of medical identity theft


Report Fraud

Help us eliminate this costly problem.  If you suspect fraud, please contact us: 

Toll-Free 1-800-314-0025

Fill out our online fraud report form. 

Mailing Address:
BlueShield of Northeastern New York
Attn: Special Investigation Unit 
PO Box 15013
Albany, NY 12212


All information will be held in the strictest of confidence.

Suspect Fraud?

Call us now, toll-free