Common law couple caught falsifying health care policy

A Blue Cross Blue Shield of Michigan member had placed their common law spouse on their health care policy for several years. Because the spouse was ineligible for coverage, Blue Cross Blue Shield of Michigan was alerted through email.

Corporate and Financial investigators reviewed the member’s records. They found services billed for the spouse in question. The woman had completed medical forms where she listed her spouse and two children.

The investigators learned that the couple had never married, even though they told others they had in 2008.

The couple pleaded guilty to one count each of larceny by false pretenses. Each was sentenced to probation. They also had to pay restitution and investigative costs. The man was fired for falsifying his insurance policy. His employer said, “We paid over $20,000 to have the ineligible member on his insurance policy, and we never required a marriage certificate.”

This crime would’ve continued if we hadn’t received an email in the CFI Fraud Inquiry mailbox.

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