Doctor who had office staff treat patients tallies $900,000 in fraudulent reimbursements

An investigation by Michigan's Office of the Inspector General revealed that a Michigan physician was billing health insurance companies for physical therapy services that he did not personally perform. In fact, the services were performed by unqualified, unaccredited office staff, but the doctor claimed he'd performed the services. 

The Centers for Medicare and Medicaid Services audited a random sample of the bills the doctor submitted to insurance companies. The audit showed that 90 percent of those bills should have been denied payment because they were not performed by the doctor.

Further investigation showed that 90 percent of all the bills the doctor submitted between 2004 and 2008 were for fraudulent services, equaling over $900,000 in claims payments. Of that $900,000, more than $187,000 was paid by Blue Cross Blue Shield of Michigan and Blue Care Network.

The doctor pleaded guilty to health care fraud — a felony offense. He could serve up to 10 years in prison and pay a $250,000 fine.

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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