Coordinated investigative effort

In late January 2010, the Blue Cross Blue Shield of Michigan Anti-Fraud Hotline received a call from a member claiming someone had used her name and insurance coverage to obtain Vicodin from CVS/pharmacy. Through information provided by the member and CVS/pharmacy, Corporate and Financial Investigations traced the origin of the called-in prescription to a specialty unit within a major Southeastern Michigan hospital.

The CFI investigator engaged the assistance of the University of Michigan Public Safety Department, who took little time to identify an employee as the suspect. Computer records were examined, and a determination was made that the suspect had been accessing employee records. The suspect was questioned regarding her involvement, and she confessed to the crime. A second incident was discovered that also involved the illegal use of another member's name and contract information.

The suspect was charged. Since then, she has entered a guilty plea and has been sentenced.

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.

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