Blue Cross sues doc for defrauding $565K

Blue Cross Blue Shield of Illinois is suing a doctor for fraud, claiming she cheated almost $565,000 from the company.

Cecilia Ibrahim, an internist who is part of the largest physicians practice in the Chicago area, allegedly used an experimental procedure to treat patients with lower back pain. Although Blue Cross doesn't cover the treatment, she "knowingly and deliberately" submitted claims to be reimbursed for a covered procedure, Crain's Chicago Business reported.

In a complaint filed in Cook County Circuit Court by Blue Cross owner, Health Care Service Corp, the insurer claimed that between March 2006 and October 2008 Ibrahim submitted 1,899 claims with a medical code referencing the surgical decompression of a nerve. But after reviewing those claims, Blue Cross determined the patients received a different procedure with a different code. Ibrahim actually provided intervertebral differential dynamics therapy, "a non-surgical, non-invasive procedure," Blue Cross said.

It's a rare move for an insurer to sue a doctor for fraud. In most cases, insurers refer the cases to appropriate law enforcement to take action on their behalf. In fact, HCSC's own fraud department usually contacts local police or the FBI about potential fraudulent activity so they can subpoena the insurer's extensive records to begin building a case, FierceHealthPayer previously reported.

To learn more:
- read the Crain's Chicago Business article

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