What to Know About Fraudulent Covid Testing Labs
Lindsay Knake
| 3 min read
Lindsay Knake is a brand journalist for Blue Cross Blue Shield of Michigan.
Since the Covid-19 pandemic, there have been schemes to defraud insurance companies with false Covid-19 tests.
Here’s what to know about these phantom labs, what Blue Cross Blue Shield of Michigan is doing to protect members, how this fraud affects health care affordability and what you can do to avoid these schemes.
Covid-19 phantom labs
This Covid-19 fraud scheme involves criminals purchasing spaces in empty buildings or non-functional labs. These bad actors then share member contract numbers and submit fraudulent claims to health insurance companies for Covid-19 testing that never occurred. They submit false claims in bunches, collect the insurance payouts and then move onto the next fraudulent “phantom lab” and repeat the process.
Blue Cross Blue Shield of Michigan’s Corporate Fraud Investigations (CFI) team works to identify schemes like this and prevent payouts to these labs.
Health care fraud is an intentional act to defraud an individual, health care provider or insurance plan. It’s a felony that can lead to increased health care premiums. All types of health care fraud account for 3% to 10% of all health care expenses, which could be more than $300 billion a year, according to estimates from the National Health Care Anti-Fraud Association (NHCAA). These financial losses add strain to the whole health care system, leading to higher premiums and out-of-pocket costs.
The Blue Cross CGI team of investigators, data analysts and clinical and claims specialists use a variety of tools to look for suspicious providers and trends to ensure all of our members get the care they need.
How to check for and report health care fraud
While the CFI team looks to identify fraud, waste and abuse, Blue Cross members can also take steps to protect themselves against fraud. Here are a few tips:
- Review your Explanation of Benefits (EOB) and look for Covid-19 tests you didn’t receive, laboratory names you don’t recognize or multiple tests billed when you only received one. Members can view this information in their online account or in the mobile app, and they can also talk to their health care provider if they have questions about their EOB.
- Contact the testing site or health care provider if something looks off.
- Report suspicious or unfamiliar claims to the Blue Cross toll-free Fraud Hotline at 844-STOP-FWA or the Medicare and government business Fraud Hotline at 888-650-8136. Hotline specialists answer calls from 8:30 a.m. to 4:30 p.m. daily, and callers can leave a voicemail message after hours. You can also send an email to stopfraud@bcbsm.com or file a report at this link.
By reporting concerns, you can help to ensure claims are accurate and keep health care costs down for everyone.
If you are looking for a Covid-19 test, here are some things to keep in mind:
- Talk to your primary care provider (PCP) about where to get a Covid-19 test or seek one from a trusted provider. At-home tests are available via grocery stores and pharmacies, and you can also get tests directly from many pharmacies.
- Don’t share your medical or insurance information if something seems off and contact your PCP or insurance provider.
- Beware of "free" medical services, as this can be a tactic to obtain sensitive information. Even if you are not being charged, the fraudulent provider can still bill Blue Cross.
Image: Getty Images
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