Blue Cross Blue Shield of Illinois notifies members after vendor alerts them to a fraudulent provider

Blue Cross Blue Shield of Illinois  (BCBS) uses a vendor, Dane Street, to provide peer to peer reviews of insurance claims that are denied.

On May 10, Dane Street notified BCBS that on April 9, law enforcement had notified them that a doctor who had been providing peer to peer reviews for them was not the named doctor and had appropriated someone else’s identity.

You can read the template notification letter here.

The number of affected members was not disclosed in the letter, nor was the first date when the fraudulent reviews commenced.  The incident is not up on HHS’s public breach tool at this time, either.

BCBS noted that the fraudulent doctor had not worked for Dane Street since October 5, 2017, so this breach only potentially impacted those reviews that occurred before that date and after the provider’s start date, which was not indicated in the letter.

About the author: Dissent

Comments are closed.