Health Care Fraud Prevention

Reporting Fraud

Reporting suspect fraud is everyone's responsibility. Report suspected fraud to the CareFirst Special Investigations Unit by:

  • Calling 410-998-5480 or toll-free at 800-336-4522 (Phone calls can remain anonymous.)
  • Completing the online form

Identifying Fraud

Health insurance fraud has many forms, but collectively it is costing upwards of $85 billion a year, according to the US General Accounting Office. The most common types of fraud include:


  • Using a member ID card that doesn't belong to them
  • Not removing someone from their policy when they're no longer eligible (for example, former spouses or children who are no longer dependents)
  • Adding someone to their policy that isn't eligible (for example, grandchildren or overage dependents)
  • Doctor shopping - visiting several doctors to obtain multiple prescriptions (often for controlled substances)


  • Billing for services that were offered for "free"
  • Billing for services that weren't provided
  • "Upcoding" - charging for a more complex or expensive service than was actually provided
  • Billing for a covered service when the service actually provided wasn't covered
  • Billing for services provided to their own family members

Please help us fight fraud by letting us know when you encounter the following:

  • An Explanation of Benefits (EOB) showing services that you did not receive or showing providers or dates of service that are not correct
  • Someone using a member ID card that is not theirs
  • A member adding someone to his or her policy that is not eligible or not removing former spouses or children who are no longer dependent from a policy
  • Billing for services that were not provided
  • Billing for services that are more complex than the service that was performed

Preventing Fraud

You can help prevent fraud by keeping your member ID in a safe place. If your ID is stolen, report it immediately.