Attentive member spots improper charges

After a recent visit to the ophthalmologist, a Blue Cross Blue Shield of Michigan member received her Explanation of Benefit Payments statement and noticed something odd. She saw services listed that she didn't receive. This put up a red flag and she called the Blues Anti-Fraud Hotline number she saw listed on her Explanation of Benefits statement.

Our Corporate and Financial Investigations department did some research and found that this ophthalmologist had been billing improperly for other patients as well. We contacted the ophthalmologist, who then refunded us for all of the improperly billed services.

Thanks to a member who not only took the time to review her Explanation of Benefits statement, but took the extra time to call us, these improper billings were put to a stop.

Not every call to our Anti-Fraud Hotline results in criminal prosecution. Sometimes the call results in the recovery of money that we paid to a health care provider that should not have been paid.

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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