Accidental shooting, call from employer lead to fraud conviction
A call to the Blue Cross Blue Shield of Michigan Anti-Fraud Hotline led to the investigation of an individual for having an ineligible dependent on his insurance coverage.
In 2001, Bernard R. Fogle, a member employed in Anderson, Ind., added his girlfriend to his employer-sponsored coverage as his "wife."
In 2005, Fogle's girlfriend was accidentally shot while a family member was working on a muzzleloader rifle. Fogle's employer became suspicious when articles in The Herald Bulletin newspaper described the incident and identified the shooting victim as Fogle's girlfriend.
The employer contacted the our Anti-Fraud Hotline and reported the allegations. Corporate and Financial Investigations initiated an investigation and confirmed that Fogle was not married to his girlfriend. The investigation identified $122,597 in services we had paid for the ineligible member.
The case was presented to the Anderson Police Department, which referred the matter to the Madison County Prosecutors Office. Fogle was charged with one Count of Insurance Fraud and subsequently pled guilty to the charge. Fogle was sentenced in Indiana Superior Court to four years imprisonment and ordered to pay $122,597 in restitution to Blue Cross Blue Shield of Michigan.
Health care fraud increases health care costs for everyone. As part of its cost-containment efforts, Corporate and Financial Investigations continues to work with federal, state and local law enforcement agencies in their efforts to seek prosecutions those who commit fraud against Blue Cross Blue Shield of Michigan.
Members who suspect health care fraud are urged to call our Anti-Fraud Hotline at 1-800-482-3787, or report fraud through our website.