Report Fraud, Waste and Abuse

If you believe a: 

  • Doctor

  • Dentist

  • Counselor

  • Someone with health benefits

has committed fraud, waste or abuse, you have a responsibility and a right to report it. You also have the right to remain anonymous when reporting fraud, waste and abuse. 


Find out as many details as you can before reporting fraud, waste or abuse. There are four ways to report fraud, waste or abuse to us: 

BlueCross BlueShield of South Carolina Anti-Fraud Unit

Mail Code: AC-200 PO 

Box 24011 

Columbia, SC 29224-4011 


You may also call or email the South Carolina Medicaid Fraud Hotline: 


When you report a provider, give these details: 

  • Provider name

  • Provider address

  • Provider phone number

  • Name and address of the hospital, nursing home or home health agency 

  • Medicaid number of the provider (if you know it)

  • Type of provider

  • Names and phone numbers of other people who can give us details

  • Dates of events

  • A brief description

When you report someone who receives benefits, give these details: 

  • The person’s name

  • The person’s date of birth (if you know it)

  • The person’s Social Security number (if you know it)

  • The city where the person lives

  • Information about what happened


What Are Fraud, Waste and Abuse? 

Fraud means misrepresenting information on purpose. It could cause you or someone else to get an unapproved benefit. Fraud can be: 

  • Using someone else’s Social Security number to get government help. 
  • A doctor billing for services on purpose that they did not give.

You can lose your Medicaid benefits if you commit fraud. 


Waste is the overuse of services or careless practices that cause the spending of health care or government resources in the wrong way. Examples of waste: is the overuse of services or careless practices that cause the spending of health care or government resources in the wrong way. Examples of waste are: 

  • A doctor giving more medicine than necessary. 
  • A doctor giving more health care services than necessary.


Abuse is something that creates unnecessary costs for government programs such as Medicaid. Abuse may also result in members getting benefits they shouldn’t receive or doctors getting paid for services they shouldn’t have. Examples of abuse include:

  • Asking for and getting medications or medical equipment for someone else. 
  • Overuse of the emergency room for nonemergency or routine care.
How We Combat Fraud, Waste and Abuse

To help fight these scams, our team: 

  • Looks at claims and information to spot anything odd.
  • Checks out doctors’ billing patterns for strange charges. 
  • Works with other health care companies to track strange activity. 
  • Partners with police to look into cases that may be fraud.
  • Makes sure all of our employees are trained to spot odd claims.
How You Can Help
  • Take a good look at free offers. Make sure they are part of your plan. If you are not sure if the offer is part of your plan, reach out to us at 866-781-5094 (TTY 866-773-9634).
  • Keep your member ID card in a safe place. Let us know if you lose your member ID.