Chiropractor found guilty of fraud — services for his children were never rendered

The Corporate Financial and Investigations department received a complaint from Anthem Blue Cross and Blue Shield of Ohio in June 2014. Anthem alleged that chiropractor, Sebastian Wilson, was submitting claims for services not rendered. A CFI investigator went to Dr. Wilson’s office to obtain patient files and discovered that the files didn’t exist.

Several witness interviews were conducted, and the investigation was referred to the Michigan State Police — Coldwater Post for criminal review. An eight-count warrant was issued, charging Dr. Wilson with health care fraud.

Dr. Wilson was arrested. He declined a plea agreement and opted to go to trial. After a two-day trial, it took less than an hour for the jury to find Dr. Wilson guilty on all eight counts of health care fraud.

The CFI investigator assigned to the case played a key role in Dr. Wilson’s conviction. The investigator testified on the stand for more than an hour, confirming that 342 claims were billed.

In 32 of those claims, the chiropractor said he performed services on himself. In addition, the investigator’s testimony revealed that Dr. Wilson billed services for his children. But the investigator obtained perfect school-attendance records for all dates that those services were allegedly performed. This disproved Dr. Wilson’s defense that he actually performed those services.

We urge Blue Cross Blue Shield of Michigan and Blue Care Network members who suspect health care fraud to call our Anti-Fraud Hotline at 1-800-482-3787 or to report fraud at bcbsm.com.