The Independence Blue Cross (IBC) Corporate and Financial Investigations Department (CFID) uses a sophisticated software data–mining tool to analyze all claims submitted by medical providers, facilities, and pharmacies and compares them against member enrollment and benefits. Any trend, pattern, or aberrant billing practice is targeted for an in–depth audit or investigation.
Additionally, CFID works closely with state and federal law enforcement, regulatory agencies, and other insurance companies when the facts and evidence warrant it.
Health care fraud is a violation of state and/or federal law. Under federal law it is a felony offense (18 USC 1347), punishable by a fine of up to $250,000, and/or up to 10 years’ imprisonment. If the violation results in serious bodily injury, up to a 20–year prison term is possible.