Registered nurse forges prescriptions

Corporate and Financial Investigations was contacted in January 2015 by a doctor in Kalamazoo, Michigan, who received a notice from Blue Cross Blue Shield of Michigan Pharmacy Services. The doctor was notified that one of his patients was receiving many prescription pain medications from various medical providers. The doctor contacted CFI because he had never prescribed any pain medication for the patient. 

An investigation by CFI and law enforcement determined the doctor’s patient wasn’t receiving the prescriptions. But they were called in by his mother, a nurse who worked for the doctor. The investigation also showed she was calling in prescriptions for herself and her son using various pharmacies. She had been calling in prescriptions for herself for about 15 years but recently began calling them in using her son’s name as the patient. 

The suspect was arrested and charged with obtaining a controlled substance by fraud. In October 2015, she pleaded guilty and entered a drug treatment program through the Ninth Circuit Court. We urge all Blue Cross and Blue Care Network members who suspect health care fraud to call our Anti-Fraud Hotline at 1-800-482-3787.