The Blues Anti-Fraud Unit Recouped More Than $270 Million

The Blues Anti-Fraud Unit Recouped More Than $270 Million

Blue Cross Blue Shield of Michigan’s health care fraud investigation unit, the oldest and most successful health plan operation of its kind in the U.S., saved or recovered nearly $277 million since it first began operation nearly 30 years ago.

During 2009 the BCBSM anti-fraud unit acted on 2,300 tips involving suspected fraud. Its investigations led to 149 arrests and 94 convictions, and resulted in nearly $15 million saved or recovered in 2009 alone. Health care fraud constitutes nearly 3 percent of all health care spending, according to the National Health Care Anti-fraud Association.

“Our anti-fraud activities help ensure that critical health care dollars are being spent appropriately,” said Daniel J. Loepp, BCBSM president and CEO.

Telephone calls to BCBSM’s toll-free, anti-fraud hot line are the starting point for most investigations, with explanation of benefits statements to Blues’ members prompting approximately 70 percent of all hot line calls when members notice irregularities on their statements. BCBSM also has an online method of reporting fraud through its website

The unit’s members have law enforcement backgrounds in surveillance, undercover work, credit card fraud and narcotics, while others come from inside the company with experience in auditing, security and nursing.

If you or anyone you know has information about suspected health care fraud in Michigan please call the BCBSM toll-free, anti-fraud hotline at 800-482-3787, between 8:30 a.m. and 4 p.m. Monday through Friday. Click here to learn more about The Blues’ anti-fraud efforts.

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