The National Heath Care Anti-Fraud Association estimates conservatively that health care fraud costs the nation about $68 billion annually — about 3 percent of the nation's $2.26 trillion in health care spending. Other estimates range as high as 10 percent of annual health care expenditure, or $230 billion.

Health care fraud is a felony under Michigan's Health Care False Claims Act, punishable by up to four years in prison, a $50,000 fine and loss of health insurance. It's also a federal criminal offense under the Health Insurance Portability and Accountability Act. 

Blue Cross Blue Shield of Michigan's fraud investigation unit coordinates investigations with the FBI, the Office of Inspector General for the U.S. Department of Health and Human Services, Michigan State Police and local police departments. It also assists with state and federal prosecutions.

Current Statistics

The following data represents Blue Cross Blue Shield of Michigan's fraud investigation unit activity from July 1980 to November 2016.

Cases opened: 50,607

Cases closed: 49,480

Referred for recovery/cost savings: $409,327,259.84

Many cases handled have resulted in referrals to law enforcement agencies.

          Law enforcement referrals: 4,396

          Warrants issued: 3,500

          Arrests: 3,441

          Convictions: 2,858


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