An employee of an Adrian dental clinic was found to have defrauded both her employer and Blue Cross Blue Shield of Michigan.
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. The Sheriff’s Department contacted our Corporate and Financial Investigations because several of the checks were issued by us.
Further investigation revealed that not only had this employee embezzled from the dental clinic, but she had submitted false claims to us 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 Blue Cross Blue Shield of Michigan. The defendant will re-pay us $14,923.56 and her (now former) employer $9,566.19.
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Content retrieved from http://www.bcbsm.com/health-care-fraud/fraud-files/archive/employee-embezzles-reimbursement-checks-at-adrian-dental-clinic.html