Blues plans team to tackle bogus billing

Fraud has no boundaries.

Cooperation between Blue Cross Blue Shield plans in different states is an important weapon in our fight against health care fraud. Working together led to the recent arrest of six people engaged in a fraud scheme in the Dallas area. The investigation began in 2010 when a member in Michigan reported that employees in a Texas manufacturing facility were being recruited to commit fraud.

The report was that workers could receive cash or documentation to get time off work if they turned a blind eye when their insurance contracts were billed for services that were never provided.

Michigan and Texas Blues plans shared information and ideas. Then authorities launched an investigation.

Interviews by the Texas Blues team confirmed that people had services billed to their contracts by a chiropractor and occupational therapist they had never met. The conspirators submitted claims of more than $4 million. They were paid $2.1 million.

The case was turned over to the FBI. Indictments were issued in April against the owner of the physical therapy clinic, two employees, the chiropractor and the occupational therapist who participated in the scheme. The recruiter who acted as the link between the factory and the clinic was also indicted.

Four of the defendants immediately pled guilty. The chiropractor and recruiter went to trial and were convicted on all counts. They face up to 10 years in prison.

All of the defendants are expected to be sentenced by the end of 2014. If you suspect health care fraud, call our anti-fraud hotline at 1-800-482-3787. You can also report fraud through our website at bcbsm.com.