Honesty is the best policy

The Corporate and Financial Investigations department received an anonymous complaint that accused a Blues member of committing fraud. The former employee of a large mental health institution in Michigan reportedly held an ineligible dependent on her health insurance contract for more than 21 years.

The member began her employment in 1990, and soon after, she reportedly placed her live-in ex-spouse on her benefits plan. The suspected fraud wasn’t discovered until 2012, when the woman reportedly said by accident that she was actually divorced during a conversation at work. Word quickly spread, and she was terminated on suspicion of defrauding the self-insured group.

Random providers over the past 20 years were contacted and asked if the ex-spouse filled out patient demographics regarding his marital status. All the providers contacted indicated that the ex-spouse completed forms stating he was currently married.

Claims totaled more than $47,700.

The case was presented to the Wayne County Prosecutor’s Office for review. Both suspects were charged with conspiracy to commit health care fraud-false statements. The case is currently pending.

We urge Blues members who suspect health care fraud to call our Anti-Fraud Hotline at 1-800-482-3787 or to report fraud through our website.