Pharmacy employee commits fraud

The Corporate and Financial Investigations Department investigated a fraud scheme identified by the Pharmacy Services area in 2012. An independent Southfield pharmacy was identified as filling more prescriptions paid with cash for Blue Cross Blue Shield of Michigan members than all of the other 3,120 network pharmacies in Michigan. Between 2010 and 2012, this pharmacy took in $344,762.61 in cash payments, even though members had prescription coverage and only should have been responsible for their respective copays. A deeper examination revealed that only 13 Blue Cross members were the recipients of the medications allegedly dispensed.

A three-year investigation, working in conjunction with the FBI and the U.S. Attorney’s Office, revealed that a pharmacy employee, Angela Kamposh, was the mastermind of the fraud scheme. Kamposh produced false receipts, created bogus prescriptions and forged reimbursement documents in the names of family members and friends to generate a reimbursement from Blue Cross. On Jan. 15, 2015, Kamposh was charged in the U.S. District Court, Eastern District of Michigan, with one count of health care fraud. Kamposh pled guilty and was sentenced in July 2015. Kamposh was ordered to serve 24 months in a federal prison and pay restitution to Blue Cross in the amount of $336,212.

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.