Commissions recovered from contracted independent agents
Blue Cross Blue Shield of Michigan partners with independent agents. We pay them commission to enroll eligible groups and individuals in our health insurance plans. To win business, they may compete with fellow agents for some of the same clients and commissions.
Competition is fair, but only if the playing field is level. We're forced to recover commissions when an agent tilts the level of the playing field in his or her favor, by either a deliberate act or by an act of omission.
Here are some examples of instances when this has happened.
- The Blue Cross Blue Shield of Michigan Underwriting department canceled the contracts of four ineligible group members. We later discovered that the agent re-enrolled the four group members retroactive to the date of cancelation without approval from the Underwriting department. We recovered two years of commissions from the agent.
- A business owner closed his business, arranged to collect premiums from former employees and misrepresented the group as being eligible. The business owner was prosecuted and convicted. Our investigation revealed the agent failed to service the group for three years, so he or she was unaware the business had closed. We recovered three years of commissions from the agent.
- A business owner closed her Michigan business and opened a new business in Florida. She maintained health insurance coverage for her employees by using the former Michigan address instead of the new Florida address. Our investigation showed the group’s agent had sub-contracted his small groups to an out-of-state insurance agency, which failed to inform the agent of the move. We recovered two years of commissions from the agent.
Agents are responsible for knowing the terms and conditions of their agent contracts and for being aware of agent policies and procedures. These are all available in Agent Secured Services.
Members who suspect health care fraud should call our Anti-Fraud Hotline at 1-800-482-3787 or report fraud through our website.