Southfield social worker swaps free trips for seniors' billing information
The Internal Revenue Service alerted Corporate and Financial Investigations about a scheme that involved the use of Blue Cross Blue Shield of Michigan subscriber information to submit fraudulent claims for psychotherapy services not rendered.
An IRS source was approached by a recruiter for Terrell Cunningham, M.S.W., who inquired if the source was familiar with any senior citizens who had Blue Cross Blue Shield of Michigan insurance. According to the recruiter, these seniors could take trips at no cost, as the trips would be billed to Medicare and Blue Cross Blue Shield of Michigan as "therapy."
Recruiters visited seniors at their homes or arranged group meetings of seniors at third party residences to get their insurance information. They also distributed flyers to participants that advertised free events, which included trips to the movies, plays, dinner at area restaurants and mall shopping.
The seniors thought this was a wonderful arrangement because they didn't have the money or transportation for these outings.
All participants in the free events were told to notify the recruiter if they were hospitalized so that no claims would be submitted to Medicare or Blue Cross Blue Shield of Michigan during their hospitalization.
Some of the seniors questioned the appropriateness of these trips being billed to Medicare and us. One senior did call the Anti-Fraud Hotline, and said she never received psychotherapy services from Cunningham, and she had never heard of him.
Another call to the hotline resulted in Cunningham being contacted about a complaint services not rendered. He subsequently faxed 40 pages of progress notes to us.
Investigators noticed that the notes were very generic, and Cunningham had submitted two sets of progress notes for the same date of service with slightly different information.
The calls to our Anti-Fraud Hotline plus the information provided by the IRS source led to additional interviews with senior citizens. The seniors interviewed had never received psychotherapy services nor had they heard of Cunningham.
All seniors had been approached by recruiters employed by Cunningham and an associate who obtained their Medicare and Blue Cross Blue Shield of Michigan information for billing purposes. All recruiters were paid a commission by Cunningham for each senior they recruited. One of these recruiters was paid tens of thousands of dollars for her recruitment efforts.
Cunningham was charged with a federal crime and eventually pleaded guilty to one count of health care fraud. Cunningham was placed on probation and ordered to pay restitution to Medicare and us.
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.