Fraud case files archive

Subscriber's review of benefits statement uncovers identity theft by illegal alien

When a Blue Care Network subscriber reviewed her Explanation of Benefit Payments statement and discovered something suspicious, she contacted BCN. The EOB she received had a stranger's name on it. A BCN project manager investigated only to discover two subscribers with the same Social Security number in the BCN and Blue Cross Blue Shield of Michigan systems.

Upon further investigation, it was discovered that the other subscriber was an illegal alien who had a fake Social Security card with the BCN subscriber's number, and fraudulent naturalization papers. They were excellent forgeries — good enough for the man to fool an employer and get a job. None the wiser, the company put him on its Blue Cross health care policy.

If the BCN subscriber had not been diligent enough to review her EOB or had not called BCN to investigate why a stranger's name was on it, the man would have continued to use her Social Security number. In January 2008, the man was charged with three counts of health care fraud, insurance fraud and insurance identity theft.

Michigan Blues members who suspect health care fraud are urged to call the Blues Anti-Fraud Hotline at 1-800-482-3787, or report fraud through this website.