Fraud and abuse

Healthcare fraud

  • What is healthcare fraud?

    Healthcare fraud occurs when a false claim is deliberately submitted to a health plan. It affects virtually everyone, taking critical dollars out of our already financially overwhelmed healthcare system.

    The National Healthcare Anti-Fraud Association estimates that as much as $50 billion is lost annually in the United States to healthcare fraud. The U.S. General Accounting Office reports that this figure might even be as high as $120 billion. It’s easy to see why losses of that magnitude affect costs for consumers, providers and insurers.

    Those who commit healthcare fraud can face fines and/or jail terms. For example, making false or misleading statements on a health plan application carry a penalty of up to five years in prison.

  • How does Premera combat fraud?

    At Premera, it’s critical that we do all we can to prevent, detect, and investigate healthcare fraud and abuse by providers, producers, employer groups or members. Premera has a Special Investigations Unit to look into suspected instances of fraud. We also have a Fraud Hotline you can call anytime 888-844-8985 to report fraud.

  • How can you prevent fraud?
    • Guard your health insurance ID number as you would credit card information
    • Check your Explanation of Benefits (EOB) for inflated charges, incorrect billed services or dates of service and any false statements
    • Call our Fraud Hotline, 24/7 at 888-844-8985 to report possible fraudulent activity
  • What is a phishing scam?

    The term “phishing” refers to the attempt to acquire sensitive information such as credit card details, Social Security numbers, and other personal protected information by falsely posing as a trustworthy entity, usually in an electronic communication (telephone, email, instant messaging).

    The purpose of phishing is to steal your identify or personal protected information through deception, and to use that information for fraudulent activity and scams. Phishing attempts may use trusted organization logos, names and styles to deceive victims into providing personal protected information.

    Legitimate emails from Premera will never ask you for your username/password, Social Security number, financial data, or other personal protected information. We will also never threaten to cancel your coverage if you do not supply this information. If Premera contacts you via phone, it will only be in follow up to your previous inquiry and we will not ask for your personal protected information.

  • How can I identify a phishing scam?
    • Very generic greetings or mistakes in the greeting
    • Misspellings or grammatical errors
    • A false sense of urgency, for example, “you must take immediate action or we will cancel your contract”
    • Links in email that take you to non-Premera sites
    • Telephone calls from unrecognized or suspicious area codes
    • Callers who are unable to answer basic questions such as which providers are in the network, the status of your claims, etc.
  • How can I protect myself from a phishing scam?

    To safeguard your personal protected information from phishing scams and other fraudulent behavior:

    • Remember Premera will never contact you to solicit your personal protected information
    • Do not provide your personal protected information to anyone who calls or emails you unrelated to an inquiry you made
    • Proceed with caution. Do not make any decisions before investigating the details
    • Never email personal or financial information unless via our secure member site
    • Safeguard your member ID card at all times and do not give out your information contained on the card to anyone other than your doctor, hospital or pharmacy
    • Hang up on fake phone requests
  • How can I report a scam to Premera?

    You can call us 24 hours a day to report suspicious activity:

    888-844-8985

This application is not a guarantee that you will receive coverage. Upon approval of your application, you will receive an approval letter and a contract.
You can become a Premera Blue Cross Blue Shield of Alaska (Premera) Medicare supplement member if you:
Reside in Alaska,
Currently have both Medicare Part A and Part B, and
Don't receive Medicaid assistance other than payment of your Medicare Part B premium.

You do not need more than one Medicare supplement plan. If you currently have a Medicare supplement plan or Medicare Advantage plan (including a Medicare HMO or PPO), you cannot be enrolled unless you intend to replace your current coverage. Please complete a replacement form. If you purchase this contract, you may want to evaluate your existing health coverage and decide if you need multiple coverages.

You may be eligible for benefits under Medicaid and may not need a Medicare supplement plan. Medicaid is a public aid program for people with low income. It is not the same as Medicare.

If, after purchasing this plan, you become entitled to Medicaid, the benefits and subscription charges under your Medicare Supplement contract can be suspended, if requested, during your entitlement to benefits under Medicaid for 24 months. You must request this suspension within 90 days of being eligible for Medicaid. If you are no longer entitled to Medicaid, your suspended Medicare supplement plan (or, if that is no longer available, a substantially equivalent plan) will be re-instituted if requested within 90 days of losing Medicaid eligibility.

Counseling services may be available in your state to provide advice concerning your purchase of Medicare supplement coverage and concerning medical assistance through the state Medicaid program, including benefits as a "Qualified Medicare Beneficiary" (QMB) or a "Specified Low-Income Medicare Beneficiary" (SLMB).

Except that you must provide information on diseases and disorders for which you have symptoms, please do not provide any information on any part of this application about genetic testing or genetic information, including any decision by an insurance company that is based on a genetic test or genetic information.

 Plan A 021202 (06-2010); 021198 (06-2010); Plan N 021203 (06-01-2010); 021199 (06-01-2010); Plan F 021204 (06-2010); 021200 (06-2010); High Deductible Plan F 021205 (06-2010); 021201 (06-2010); Plan G 042196 (01-2018); 042195 (01-2018)