The Corporate and Financial Investigations, or CFI, team staff at Blue Cross Blue Shield of Michigan is composed of:
The staff certifications include accredited health care fraud investigators, certified fraud examiners, certified professional coders and registered nurses.
The investigative team is dedicated to proactive data mining across all lines of business using current data analysis tools. The team possesses expertise in medical coding, clinical experience, and data analysis. Algorithms are used to analyze claim files to identify suspected fraud, waste or abuse. The team strives to proactively identify irregularities to protect our customers.
CFI has an established Government Programs Investigative Team that was formed to comply with the guidelines created by the Centers for Medicare & Medicaid Services. Key functions include strategies to address and reduce fraud, waste and abuse, or FWA, across the enterprise, including Medicare, Medicaid and the Federal Employee Program. The team investigates all allegations of fraud against government programs and refers completed investigations to the appropriate governmental agency.
CFI monitors a fraud hotline for employees, members and providers to report concerns of potential fraud. Hotline specialists answer calls from 8:30 a.m. at 4:30 p.m. daily and callers can leave a voicemail message after hours. Callers can choose to remain anonymous. Blue Cross Blue Shield of Michigan maintains a policy which enforces non-retaliation and non-intimidation against those who report potential concerns.
Members can also report fraud through the Blue Cross Blue Shield of Michigan mobile app.