West Branch Plastic Surgeon Convicted of Fraud
An anonymous tip to Blue Cross Blue Shield of Michigan's Corporate & Financial Investigations Department led to the arrest and fraud conviction of a Michigan plastic surgeon.
The tip alleged Doris Nelson, M.D., of West Branch, was performing chemical peels for cosmetic purposes and billing the services with a false diagnosis.
Interviews, searches of Nelson's home and office, and several undercover visits by CFI and Michigan State Police investigators confirmed that Nelson was falsely diagnosing patients with pre-cancerous lesions so she could receive payment for non-covered services. After reviewing the evidence, the Ogemaw County Prosecutor filed charges of health care fraud against her.
Nelson pleaded guilty to one count of health care fraud, one count of attempted health care fraud, and one count of larceny by false pretenses. She was sentenced to six months in jail and 24 months probation and ordered to pay $505,220.64 in restitution and investigative costs to BCBSM.
This provider's scheme to defraud BCBSM would have continued if not for the anonymous letter sent to BCBSM.
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.