BlueCaid of Michigan

Fraud, waste and abuse

Medicaid pays doctors, hospitals, pharmacies, clinics and other health care providers to take care of adults and children who need help getting medical care. Sometimes, providers and patients misuse Medicaid resources, leaving less money to help people in our state who need care. This misuse is called fraud, waste and abuse.

Fraud, waste and abuse describe misuse of Medicaid resources. Fraud is purposefully misrepresenting facts. Waste is carelessly or ineffectively using resources. Abuse is excessively or improperly using those resources.

Help us fight fraud

BlueCaid works to detect, investigate and prevent health care fraud. You can help. Know what to look for when you receive health care services.

If you get a bill or statement from your doctor or an Explanation of Benefit Payments statement from us, make sure:

• The name of the doctor is the same doctor who treated you
• The type and date of service are the same type and date of service you received
• The diagnosis on your paperwork is the same as what your doctor told you
• Noncovered items aren't billed as covered items

Minimizing fraud, waste and abuse means Michigan can provide more care to more people and make the Medicaid program even stronger. Together, all of us can work to find, report and investigate fraud, waste and abuse.

How to report fraud, waste or abuse

When reporting fraud, waste or abuse, you don't have to leave your name. To make a report, please write:

BlueCaid Fraud Investigations Unit
Mail Code B759
Blue Cross Blue Shield of Michigan
600 E. Lafayette Blvd.
Detroit, MI 48226

Or call: 1-888-650-8136
1-800-588-2711 (TTY)

You may also report or get more information about health care fraud from the Michigan Department of Community Health. Write to:

Medicaid Program Integrity Section
Capital Commons Center Building
6th floor
400 S. Pine St.
Lansing, MI 48909

Or call: 1-866-428-0005

More information

For more information about health care fraud, contact the following organizations:

• National Health Care Anti-Fraud Association
  202-659-5955
  email fraud@nhcaa.org
• Centers for Medicare and Medicaid Services
  1-877-267-2323
• The Michigan Department of Community Health
  517-373-3500

Note: Information you submit via e-mail is not secure and could be observed by a third party while in transit. If you are sending information you would like to keep private, it would be safer to contact us by telephone, fax, or letter.