Health Care Fraud Case Files

Fraud case files

Here are some examples of real-life health care fraud cases investigated by Blue Cross Blue Shield of Michigan.

Woodhaven doctor sentenced to 16.5 years in prison and $30.3 million penalty for opioid scheme

Prosecutors said that Dr. Francisco Patino prescribed excessive amounts of opioids to patients and subjected them to unnecessary and painful spinal injections, for which he billed Medicare $50 million. 

Read more on the Patino fraud case

Troy physician accused of Medicare fraud

Dr. Sangita Patel was accused of billing Medicare for telehealth visits that were not provided and prescribing drugs that weren’t medically necessary.

Read more on the Patel case

Bay City vascular surgeon pleads guilty in health care fraud scheme

A Blue Cross employee reported that vascular services provided by a provider, Vasso Godiali, appeared excessive. Godiali of Bay City Vascular was found to be inappropriately using modifiers to unbundle claims leading to overpayments. He was also accused of billing for services that were not provided. 

Godiali was arrested and pled guilty. He was placed on prepayment review and terminated from all networks in 2015. He was ordered to pay Blue Cross $4.66 million in restitution. Blue Cross has also filed a civil lawsuit and received a judgement of $12.3 million.

Read more on the Godiali fraud case

Podiatrist pleads guilty to federal charges in sex-for-drugs scheme

Dr. Manninder S. Deswal of Lansing was accused of issuing prescriptions "in exchange for cash payments, sexual favors, and/or other illicit drugs." He pled guilty in U.S. District Court after being charged with unlawfully prescribing highly addictive opioids. Blue Cross will implement administrative actions against this provider. 

Read more about the Deswal fraud case

Pharmacy owner sentenced for billing $9 million in medications not dispensed

Mohamad Ali Makki, RPh, was accused of conspiring with others in fraudulent billing and prescribing drugs to patients without distributing them. In some cases, the medication was prescribed to dead individuals for the purpose of collecting insurance payments.

Makki, of Dearborn Heights, was arrested and ordered to pay Blue Cross $635,000 in restitution. The U.S. District Court ordered Makki to pay a total of $9.8 million in restitution. 

Read more on the Makki fraud case

Reporting Fraud

If you suspect fraudulent activity, you can report it to us confidentially. We maintain a policy that enforces non-retaliation and non-intimidation against those who report potential concerns.

File a report Learn more about reporting fraud