We work hard to keep healthcare fair and make your experience better.

That’s why we want to help you understand healthcare fraud and how to report it.

What is waste, fraud, and abuse?

Waste: Using too much of something without needing to. It’s not usually done on purpose. Waste can happen if there aren’t good rules or plans in place. For example, it's wasteful if two doctors order the same lab tests for a patient.

Fraud: Lying or tricking someone to get money or something else you want. It can be things like faking a signature, saying something that’s not true to get paid, or sending in fake medical claims. Federal and state laws also explain what is considered fraud.

Abuse: Not following the industry standard for ordering medical procedures or billing for them. For example, billing for services that aren't necessary or using the wrong billing code. People can also commit abuse, like ordering too many medical supplies when they aren't really needed.

Learn more at fighthealthcarefraud.com.

Ways to report waste, fraud, and abuse

You can report a healthcare provider in the Highmark Blue Cross Blue Shield health plan network or someone with a Highmark Blue Cross Blue Shield health plan through the Highmark Blue Cross Blue Shield Special Investigations Unit (SIU):

Online form

Report Form | Fraud, Waste & Abuse (fighthealthcarefraud.com)

Phone
1-866-847-8247 (TTY 711)

Mail
Special Investigations Unit
740 W. Peachtree St. NW
Atlanta, GA 30308