Ok I have a question about a Blue Cross Blue Shield patient that is going to an out of network provider (checks are sent to the patient not the provider) so lets say we the billers for the providers office per the request of the patient submit the claims for their dates of service under their BCBS member ID. Can the patients parent submit a claim for the same date of service under their member ID as like a dependent or is this technically fraud? I personally feel like it is because they are just collecting and cashing checks meant for the provider but I wanted to see what others thought about this and if you are like me and think this is fraud how would you go about dealing with this situation? Do you think the patient knows what their parent is doing? If you think they don't know, how would you go about telling the patient that not only is their parent committing fraud but they have dragged them into their fraudulent activities...
Or am I completely overreacting and maybe this person doesn't really understand what they are doing is fraud? I really don't know how to go about dealing with this situation so.. please HELP ME lol!
