Provider treating family members

In 2016, Blue Cross Blue Shield of Michigan conducted a pro-active analysis of health care providers that submitted claims for self-treatment or treatment of immediate family members (i.e. mother, father, sister, brother, spouse or child) and received payment for those services. After reviewing paid claims, it was discovered that a Southfield physical therapist billed Blue Cross for his immediate family members, and received payment in excess of $117,000.00. The independent physical therapist is the owner of Michigan Physical Therapy and Rehab Center in Southfield, MI. The investigation later discovered that the physical therapist allegedly submitted false claims to Blue Cross and was paid for services that he didn’t render to his immediate family members.

During an interview with Corporate and Financial Investigations staff, the physical therapist admitted to treating himself and family members, billing Blue Cross for services he never rendered and falsifying medical records. CFI worked with law enforcement to obtain criminal charges against the physical therapist for health care fraud. In December 2016, the physical therapist pled guilty in Oakland County Circuit Court and was ordered to pay Blue Cross more than $200,000 in restitution.

We urge Blue Cross and Blue Care Network members who suspect health care fraud to call our Anti-Fraud Hotline at 1-800-482-3787 or go to bcbsm.com/health-care-fraud.