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Fighting fraud
What are the Blues doing to stop fraud?
Blue Cross Blue Shield of Michigan investigates tips reported to our Anti-Fraud Hot Line and works with local, state and federal authorities to bring people who commit health care fraud to justice. Since 1980, the Blues Corporate and Financial Investigations unit has recovered or saved nearly $280 million.
Members of our investigative staff employ a combination of talents to meet the unique challenges of uncovering fraud. Most have experience in complex financial investigations, interview and interrogation, check and credit-card fraud, narcotics, organized crime, surveillance, undercover operations, consumer fraud and police administration. The remainder has expertise in the areas of benefits, claims processing, auditing, accounting and finance, and internal systems technology and security.
New anti-fraud software helps prosecute fraud crimes
Blue Cross Blue Shield of Michigan began using anti-fraud software in May 2008 to detect fraud, waste and abuse patterns in our Medicare Advantage claims.
This Web-based software is used by Blue plans across the country, and has become a valuable tool in monitoring abnormal billing patterns by health care practitioners and facilities. It also finds higher-than-normal prescription drug purchases by members.
The software has helped the Michigan Blues launch a number of fraud investigations that resulted in criminal prosecution and arrest warrants.
Because of the success of this software, the Blues are expanding the use of proactive measures to review claims submitted for every Blues benefit plan.
Michigan Blues members who suspect health care fraud are urged to call our Anti-Fraud Hot Line at 1-800-482-3787, or report fraud through our website.
Blues investigation of fraudulent doctor is made-for-TV drama
The Blues' role in bringing down a dishonest dermatologist earned a slot on an episode of "American Greed" on CNBC.
The program profiled Dr. Robert Stokes, a former East Grand Rapids dermatologist, now serving 10½ years in a federal prison. He was convicted of health care fraud in 2007 after bilking insurers, including the Blues, of nearly $2 million. Prosecutors and witnesses say Stokes also performed unnecessary and disfiguring procedures on patients and reused surgical equipment in violation of medical rules.
Did you know?
Blue Cross Blue Shield of Michigan became the first insurer in the U.S. to launch its own health care fraud investigations unit in July 1980.
