Health Care Fraud & Abuse

How Health Insurance Fraud and Abuse Cost You Money

Health insurance fraud in the United States costs Americans an estimated $80 billion a year, or nearly $950 for each family (Source: Iowa Fraud Bureau):

What Constitutes Health Insurance Fraud and Abuse

Health insurance fraud occurs when someone intentionally submits, or causes someone else to submit, false or misleading information for the purpose of altering the amount of health care benefits paid. Health insurance abuse consists of any action, against an insurer, which results in an unfair gain to the claimant, or some other person or entity, that is inconsistent with acceptable business and/or medical practices (Source: Blue Cross Blue Shield Association).


Examples of health care insurance fraud and abuse include:

What You Can Do to Help

Active identification of health care fraud and abuse, and appropriate action in response, is an expectation of every Wellmark employee and is a commitment of Wellmark's Compliance Program. Investigations of health care fraud and abuse allegations are conducted under the direction of Wellmark's Vice President Audit Services.


By taking these steps, you can help protect yourself and others from health insurance fraud and abuse:

How to Report a Case of Suspected Fraud

Contact Wellmark's Special Investigations Unit by using one of these methods:

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Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association doing business in Iowa and South Dakota.
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