Ineligible subscriber

An anonymous caller contacted the Blue Cross Blue Shield of Michigan Anti-Fraud Hotline and reported that a subscriber had added a domestic partner to his policy, even though he was still married.

Our Corporate and Financial Investigations conducted an investigation and learned that the subscriber was in the process of divorcing his wife. In the papers he filed for his divorce, the subscriber stated that he had just moved out of the residence that he and his wife shared.

Shortly after filing, the subscriber added his girlfriend to his contract with his employer. In doing so, he submitted paperwork stating that he wasn't married and that he had lived with his girlfriend for more than a year, two requirements he needed to meet in order to add someone as a domestic partner.

The investigator from CFI interviewed the subscriber who admitted that he added his girlfriend to his policy because she no longer had health insurance and had some medical issues. Claims had been submitted to Blue Cross Blue Shield of Michigan for his domestic partner that totaled more than $30,000 over a few months. 

We submitted the case to a law enforcement agency for investigation and the subscriber was subsequently charged with Health Insurance Fraud—False Statement, a four-year felony.

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.

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