Chiropractor bills for services he didn't provide
An alert subscriber in Harbor Springs was reviewing her Explanation of Benefits Payment statements when she noticed that her chiropractor was billing Blue Cross Blue Shield of Michigan for mechanical traction.
Since the subscriber believed she was not receiving mechanical traction, she questioned her chiropractor, who said it was just one of the many procedures he performed on the subscriber when she came in for treatments.
The subscriber talked with other patients of the same chiropractor and found that they, too, were being billed for mechanical traction they were not receiving. The subscriber then called the Anti-Fraud Hotline number listed on her explanation of benefits.
Corporate and Financial Investigations received the case and conducted undercover visits and patient interviews. Although the undercover operatives did not receive mechanical traction and the subscribers interviewed denied receiving it, as well, the chiropractor continued to bill for this procedure.
The case was presented to law enforcement and the Emmet County prosecutor's office charged the chiropractor with multiple counts of health care fraud. The chiropractor pled guilty and was sentenced to six months in jail and restitution to Blue Cross Blue Shield of Michigan, which included investigative costs.
Members who suspect health care fraud are urged to call our Anti-Fraud Hotline at 1-800-482-3787, or report fraud through our website.