Name of Manual - Blue Cross and Blue Shield of Minnesota

Integrated Health Management
Special Investigations Blue Cross actively investigates possible fraudulent claims
submissions from both members and providers. Fraud and abuse
investigations conducted by our special investigations department
are among the most thorough in the industry. Inconsistent charges,
forged or altered charges, or services billed but never rendered are
just a few examples of inappropriate practices that we may verify
when conducting our investigation. Our investigation process may
include, but is not limited to, record requests, audits, and survey
letters.
Blue Cross often conducts our investigations and criminal
proceedings in collaboration with outside agencies such as the
state attorney general’s office, the FBI, postal inspectors, or local
authorities. Our goal is to protect Blue Cross members and
providers from losses due to fraudulent acts.
Information about any person’s inappropriate use of a Blue Cross
policy, member ID card, or questionable billing practices should
be reported by calling our fraud hot line. The phone number is
listed in Chapter 1 — At Your Service. You may remain
anonymous if you wish.
4-30 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/19/12)