Scheme targeting elderly customers hits close to home

An elderly Blue Cross Blue Shield of Michigan member sent a complaint to our Corporate and Financial Investigations Unit in September 2016. The member said a doctor showed up “unannounced” at the member’s residence.

After further investigation, CFI determined that the doctor was working in concert with a home health care company. Their objective was to reach out to elderly members who have Medicare and Blue Cross insurance to see if they’d like to receive home health care services.

The home health care company was conducting a scheme that involved “cold calling” elderly people in attempts to drum up business. CFI conducted an interview of the managing director of a home health care company, and he said the way he conducts his business is a standard practice throughout his industry. The managing director said he and his team of marketers follow this process to target potential customers:

• The company first buys names from Salesgenie^®, a web-based company that sells names for sales leads. 
• The managing director fills out an online form to determine which customers he wants to target (for example: age range, area of residence, income). 
• This information is supplied to marketers at the home health care company to solicit elderly people for services that they didn’t seek out. 
• The marketers follow a script when talking to potential clients.

After getting a potential client, the marketers refer his or her name to a doctor. The doctor then sees the potential client face to face to determine if he or she needs home health care. Although this doesn’t officially qualify as fraudulent behavior, it’s unethical in nature.

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 to report fraud online, go to bcbsm.com/health-care-fraud.