The ends don't justify the means

You know what they say – no good deed goes unpunished. That’s especially true if the law was broken to complete the “good deed.”

In 2014, two of our Medicare Advantage members, Mr. and Mrs. Smith, went to an ear doctor in Port Huron to replace Mr. Smith’s lost hearing aid. However, his benefits only covered one hearing aid each year. He wasn’t eligible for a new one until 2015.

The audiologist owned a hearing aid company and wanted to help Mr. Smith. But her solution involved health care fraud. She offered to order the hearing aid and say it was for Mrs. Smith instead. 

The audiologist went ahead with her plan, but when Mrs. Smith found out, she wanted no part of it. She knew it was fraud for the doctor to submit a claim to Blue Cross Blue Shield of Michigan for a medical service that wasn’t for her. Mrs. Smith called the doctor and told her to cancel the order. But she had already submitted the claim and her hearing aid company had collected $2,700.

Mrs. Smith called the Blue Cross Anti-Fraud Hotline to tell them the story. We interviewed the audiologist and she admitted to submitting the fraudulent claim. She was charged with one count of health care fraud and pleaded guilty. She has to pay us back for the cost of the hearing aid and she’s no longer in our network.

It seemed like a small thing to switch the name on a claim to a health care company, but honesty is crucial for controlling health care costs. 

If you suspect health care fraud, call our Anti-Fraud Hotline at 1-800-482-3787 or visit bcbsm.com and choose Stop Fraud at the bottom of the page under Help and Information.