The pain of addiction

A subscriber in the south-central area of Michigan notified the Blue Cross Blue Shield of Michigan Anti-Fraud Hotline about prescriptions that were called into a local pharmacy using her daughter’s name. The subscriber said her daughter’s identity had been stolen and no prescriptions were written for her daughter recently. The doctor’s office, who allegedly called in these prescriptions for opioid pain medications, denied authorizing these prescriptions. 

The investigation revealed many more prescriptions written in the daughter’s name and in the daughter’s husband’s name. None of the prescriptions were authorized by any of the doctors whose names were used during the calls. Three police departments also investigated similar incidents involving the same Blue Cross members.  

A thorough investigation determined that the daughter’s husband had called in the bogus prescriptions for opioid pain medications to various pharmacies. He used his and his wife’s name to get the prescriptions.

The husband was charged with six counts of obtaining a controlled substance by fraud and pleaded guilty to one count of obtaining a controlled substance by fraud, which is a felony in Michigan. He was sentenced to five years of probation and 30 days in jail, which will be suspended if he successfully completes his probation. He was also ordered to pay restitution to Blue Cross for the prescriptions that were covered by his health plan.

He was addicted to opioid medication and his actions show just how desperate he was to get them.

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 online at go to bcbsm.com/health-care-fraud.