How We Fight Fraud

Blue Cross Blue Shield of Michigan investigates tips reported to our Anti-Fraud Hotline. Then we work with local, state and federal authorities to bring people who commit health care fraud to justice.

Since 1980, our Corporate and Financial Investigations unit has recovered more than $319 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.

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 doctors and facilities. It finds higher-than-normal prescription drug purchases by members, and helped us launch a number of fraud investigations that resulted in criminal prosecution and arrest warrants.

Because of the success of this software, we're expanding the use of proactive measures to review claims submitted for every benefit plan.

The number one thing you can do is to report health care fraud when you suspect it. You can:

• Call us using one of the numbers listed in the grey box
• Use our online form
• Download, print and mail or fax our anti-fraud complaint form (PDF)
  

You can also protect yourself against fraud by knowing what it looks like, and how scam artists operate.

• Telemarketing scams are no bargain
• Hang up on fake telephone requests
• How to recognize and report health care fraud