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Preventing Health Care Fraud


Health care fraud can be reduced and, in some cases, even prevented through heightened awareness of what may count as fraudulent conduct. Blue Cross and Blue Shield of New Mexico (BCBSNM) is committed to detecting and halting health care fraud, waste and abuse through its Special Investigations Department. This department is dedicated to protecting you and your prescription drug plan. However, BCBSNM needs your help to identify and prevent health care fraud.

There are a number of things you can do to help identify and prevent health care fraud.

View the fighting fraud checklist.

Please be aware that individuals working with Medicare Part D are not permitted to:

  • Come to your home uninvited to sell or endorse any Medicare-related product
  • Enroll you into a drug plan over the telephone unless you initiate the call
  • Ask for bank account or other personal information over the phone
  • Ask for payments over the phone or internet
  • Seek premium payments upfront or before you have been billed
  • Call a beneficiary after he or she has asked not to receive additional calls
  • Call before 8 a.m. or after 9 p.m.
  • Offer you a gift worth more than $15 or a cash payment as an incentive to enroll in a Part D plan

If you believe that you have been the victim of fraud in connection with your coverage from BCBSNM, report any suspicious activities to the Special Investigation Department's Fraud Hotline at 1-800-543-0867 or online.

Pay close attention to all explanation of benefits (EOB) forms, and be sure to review each form to ensure that you have been properly charged for any costs associated with your health insurance plan. If you need help reviewing your EOBs, seek the assistance of a family member or trusted friend.