Fraudulent claims and embezzlement

An auditor hired by a dental practice contacted the Blue Cross Blue Shield of Michigan Anti-Fraud Hotline and reported suspected fraud and embezzlement by the dental office manager/biller.

Our investigation showed that the office manager/biller had BCBSM medical and dental insurance coverage through her husband’s employer. The office manager/biller and her family received free dental services as a benefit of her employment with the dental practice. When she or a family member received dental services, she would submit a claim to BCBSM seeking reimbursement for the cost of those services, even though they were provided at no cost. Over the course of ten years, the biller submitted claims to BCBSM for nearly $34,000.

The auditor hired by the dental practice also discovered that the manager/biller had taken almost $1 million of the practice’s money over ten years and converted it to her own use. The money was deposited into a bank account in her husband’s name. 

The case was submitted to a law enforcement agency for investigation. The manager/biller was convicted of four counts of embezzlement and has been sentenced to up to 20 years in prison.  She has also been ordered to pay restitution in the amount of $972,000.

We urge Blue Cross 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.