Provider convicted of falsifying patient records

In 2015, Corporate and Financial Investigations received a complaint from the Michigan State Police about a provider. The state police said the provider had been accused of writing prescriptions for his Upper Peninsula patients without actually seeing them. The Michigan State Police conducted undercover visits, and patients were interviewed to confirm the allegations. The provider had a “cash only” business and wasn’t part of Blue Cross Blue Shield of Michigan’s provider network.           

A search warrant was issued, and state police searched the provider’s office on May 8, 2015. That same day, the provider was interviewed by the state police and investigators from Corporate and Financial Investigations.

During the interview, the provider admitted he didn’t require his patients to visit his office, and he only saw them about twice a year if they requested an appointment. The patients would pick up pre-signed prescriptions from his secretary. The provider defended that he was available by phone if any patients needed him.

The office didn’t have any patient rooms, patient tables or any medical equipment. And during their search of his office, state police discovered a large refrigerator that contained only beer and wine. 

The prescriptions the provider wrote were primarily for buprenorphine, also known as Suboxone®. It’s a drug that requires constant monitoring due to the risk of opioid addiction.

On May 4, 2016, the provider pleaded guilty in Marquette County Circuit Court to falsifying patient records. Blue Cross was awarded $17,500 in restitution for three patients’ prescriptions that were part of the criminal charges.

If you suspect health care fraud, waste or abuse, please call our Anti-Fraud Hotline at 1-800-482-3787.