As soon as you receive a statement from your doctor or an Explanation of Benefits from your insurer, read them carefully to make sure all the entries and amounts are correct.Your Explanation of Benefits includes a list of services or supplies that your healthcare provider told your heath insurance company were given to you.
If you get a bill or statement from your doctor as well, you should compare the two documents and make sure everything is in order and they both say the same thing.For example, if your EOB states that you received 10 X-rays, but your statement from your doctor says you only received one, this may be evidence of health insurance fraud – but it also may be that an assistant simply typed a zero by accident while he was inputting the information.
If you keep a personal log of your doctor visits and what happened at each visit, you also have this to compare against your EOB.;
, If you don't understand something, such as an abbreviation, ask your doctor what it means.


Especially if you were unconscious during treatment, there may be entries on your statement that you don't remember.
If you have any doubts about whether you actually received a treatment, ask to see your medical records and compare the record to your bill., Certain types of billing entries may seem legitimate but actually are cause for concern.


For example, the insurance company may have been billed for each stage of a procedure as though each stage were a separate procedure, rather than being billed a single charge for the procedure as a whole – a practice known as "unbundling" which may be fraudulent.Another type of billing fraud is referred to as "upcoding." This is when the medical professional bills the insurance company for a more costly procedure than what was actually performed., If you find any differences between your insurer's statement and your medical bill or medical record, let your insurance company know as soon as possible.


Often the problem is simply a clerical error that can be easily fixed as long as the insurance company knows about it.
However, if you suspect fraud, let your insurance company know and explain the reasons for your suspicions.
 Your insurance company may have a complaint form available online, or you can call and request an official form.


You may be able to remain anonymous, but you must include the names of the person or company suspected of fraud, as well as information about the insured., If you don't want to fill out an official complaint form or if you don't have enough of the required information to do so, find out if the company has an email where you can submit a tip.


For example, if you want to report fraud involving a Blue Cross and Blue Shield company, you can email the BCBS National Anti-Fraud Department at stopfraud@bcbsa.com.
You might use an email instead of a complaint form in situations where you weren't entirely sure about who in a company was committing the acts, or if you had more general suspicions.
 If you wish to remain anonymous, you can call the company's insurance fraud hotline to report your suspicions.


For example, if you want to report possible fraud to Blue Cross and Blue Shield, you can call the company's hotline at 1-877-327-BLUE. The hotline is available 24 hours a day, seven days a week.If your insurance company doesn't have a hotline, you can write to an agent or other insurance employee and provide the information you have about the possible fraud.
Review your statement to verify accuracy.
Ask your doctor to explain entries.
Learn to recognize some common examples of billing issues that might constitute fraud.
Report discrepancies to your insurance company.
Fill out a complaint form.
Send a tip through email.
Call the company's hotline.
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