Fraud case files

Employee embezzles reimbursement checks at Adrian dental clinic

An employee of an Adrian dental clinic was found to have defrauded both her employer and BCBSM. The woman was discovered to be embezzling insurance reimbursement checks sent to the office. She manipulated the computer system so the patient accounts appeared balanced and the missing money was not noticed. The dental clinic learned of the embezzlement from the bank where the employee was depositing the checks into a personal account through the ATM machine. The Sheriff's Department contacted BCBSM Corporate and Financial Investigations because several of the checks were issued by BCBSM.

Further investigation revealed that not only had this employee embezzled from the dental clinic, but she had submitted false claims to BCBSM for dental services supposedly rendered to her family members. The employee created the false claims in the clinic's computer system, and made the claim payable to the subscriber, so checks were issued to her home address. The woman had created claims for crowns, X-rays and mouth guards for family members. Additional research revealed that the employee had conducted the same scheme when previously employed at another dental clinic.

The woman was charged in Lenawee County with Embezzlement, Health Care Fraud, Forgery and Uttering and Publishing a Financial Transaction Device. She pled guilty and was ordered to pay full restitution to the dental clinic and BCBSM. The defendant will re-pay BCBSM $14,923.56 and her (now former) employer $9,566.19.

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