Investigation determines subscriber fraud
In June 2009, Mercy Hospice began rendering in-home hospice care to Blue Cross Blue Shield of Michigan member Sara Ylen. Mercy Hospice treated Ylen based on medical records she provided to Mercy Hospice. These medical records indicated Ylen had been diagnosed with multiple myeloma at Cancer Treatment Centers of America in Illinois, St Joseph Mercy Hospital in Pontiac and by several providers in Michigan. Mercy Hospice submitted claims to BCBSM for hospice care provided to Ylen. BCBSM paid the claims.
In 2011, the Corporate & Financial Investigations Anti-Fraud Hotline received a call, reporting suspicion that Ylen did not have multiple myeloma. CFI investigated and determined that the medical records were false. Interviews with providers and facility representatives revealed that Ylen had never been treated. They also denied that the medical records, which included X-rays and signed letters, had come from the providers. Investigation determined that the false medical records were created by Ylen using a home color computer. The false X-rays were scanned from multiple myeloma X-ray photos on the internet. Her coverage was terminated in 2011. She then convinced individuals to hold fundraisers to raise money for her medical and personal bills.
In May 2013, the Michigan State Police arrested Ylen on six felony counts, including health care fraud. In 2014, Ylen pleaded no contest to health care fraud and was sentenced to one year in jail and ordered to pay $121,424.32 in restitution to BCBSM. In 2014, Ylen was also found guilty of filing a false felony sexual assault report and tampering with evidence. For these crimes, she was sentenced to five years in prison.
Blues members who suspect health care fraud are urged to call our Anti-Fraud Hotline at 1-800-482-3787 or report fraud through the Blue Cross Blue Shield of Michigan website at bcbsm.com.