The case of the missing toenails

When members began calling our Anti-Fraud Hotline to question nail avulsions billed by Michigan podiatrist Dr. Errol Sherman, we knew something was afoot.

Routine foot care isn't a covered benefit at Blue Cross Blue Shield of Michigan, except under specific circumstances and for certain group plans. Dr. Sherman was billing this care as nail avulsions: the permanent removal of all or part of the nail. From Jan. 1, 2003, through Aug. 31, 2008, BCBSM paid Dr. Sherman $173,231.83 for nail avulsions.

So the Department of Health & Human Services and Blue Cross Blue Shield of Michigan’s Corporate & Financial Investigations department conducted a joint investigation. We interviewed Medicare beneficiaries and Blue Cross Blue Shield of Michigan members to confirm the allegations against Dr. Sherman. The doctor was charged with five counts of health care fraud by a federal grand jury.

Dr. Sherman pled guilty to one count of conspiracy to commit health care fraud. He was sentenced by U.S. District Court Judge Gerald Rosen to 12 months and one day in jail. He was also ordered to pay back $300,000 to Medicare and Blue Cross Blue Shield of Michigan.

Members who suspect health care fraud should call our Anti-Fraud Hotline at 1-800-482-3787, or report fraud through our website.

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