Alert Notices:

Fraud Alert: Suspect Charges Billed by Non-Participating Applied Behavior Analysis (ABA) Providers

Posted: June 9, 2026

Be wary of suspect charges and services from non-participating ABA providers. Red flags that could indicate improper billing behavior include:

Unusual Promises: A provider guarantees immediate treatment or implies no out-of-pocket costs, regardless of your plan benefits.
Excessive Billing: Your EOB shows an unusually high number of ABA therapy hours or exorbitant charges that seem disproportionate to services received.
Unfamiliar Provider: You receive an EOB for services rendered by an ABA provider you do not recognize or have never visited.
Services Not Received: Your EOB lists services or dates of service for ABA therapy that you or your dependent did not actually receive.

Please call to report any suspect fraudulent activity by calling or emailing FIPR.

FIPR:

1-800-438-2478 (PA/DE)

1-800-788-5661 (WV)

1-800-333-8451 or 1-800-314-0025 (NY)

Integrity Hotline:

Integrity@highmarkhealth.org

Highmark is a registered mark of Highmark Inc. © {currentyear} Highmark Inc., All Rights Reserved.

All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.

Highmark Blue Cross Blue Shield and Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal. Highmark Wholecare offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal. Highmark Health Options Duals offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal. ®Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life Insurance Company, Highmark Care Benefits Inc., Highmark Senior Health Company, or Gateway Health Plan, Inc. d/b/a Highmark Wholecare. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company, Highmark Senior Health Company, or Gateway Health Plan, Inc. d/b/a Highmark Wholecare. PA: Your plan may not cover all your health care expenses. Read your plan materials carefully to determine which health care services are covered. For more information, call the number on the back of your member ID card or, if not a member, call 866-459-4418. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield or Highmark BCBSD Health Options Inc. d/b/a Highmark Health Options. Highmark Health Options Duals is offered by Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company, Highmark Senior Solutions Company, or Highmark Health Options West Virginia Inc. d/b/a Highmark Health Options and Highmark Blue Cross Blue Shield. Highmark Health Options Duals is offered by Highmark Blue Cross Blue Shield. Visit https://www.highmarkbcbswv.com/networkaccessplan to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.