Fraud statistics
Current statistics
The following data represents Blue Cross Blue Shield of Michigan's fraud investigation unit activity from July 1980 to September 2011.
| Cases Opened |
|---|
| 40,276 |
| Cases Closed |
| 38,416 |
| Referred for Recovery/Cost Savings |
| $298,973,188.24 |
Many cases handled by BCBSM's fraud investigation unit result in further action by law enforcement agencies.
| Law Enforcement Referrals |
|---|
| 3,888 |
| Warrants Issued |
| 2,936 |
| Arrests |
| 2,791 |
| Convictions |
| 2,316 |
The National Heath Care Anti-Fraud Association estimates conservatively that health care fraud costs the nation about $68 billion annually — about 3 percent of the nation's $2.26 trillion in health care spending. Other estimates range as high as 10 percent of annual health care expenditure, or $230 billion.
While getting concrete numbers is difficult, health care fraud translates into higher premiums and copayments for consumers and reduced benefits and coverage. Fraud also hurts employers by driving up the costs of providing benefits to employees.
Health care fraud is a felony under Michigan's Health Care False Claims Act, punishable by up to four years in prison, a $50,000 fine and loss of health insurance. It's also a federal criminal offense under the Health Insurance Portability and Accountability Act.
Blue Cross Blue Shield of Michigan's fraud investigation unit coordinates investigations with the FBI, the Office of Inspector General for the U.S. Department of Health and Human Services, Michigan State Police and local police departments. It also assists with state and federal prosecutions.
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