Missouri Workers Defrauded Wellness Program

The Points to Blue program offered by Blue Cross and Blue Shield of Kansas City included an activity log whereby members could identify healthy activities in which they had participated and be awarded points. For each 1,000 points earned through healthy activities, a member would receive one dollar of credit towards the member’s choice of either a gift card or preloaded debit card, up to an annual limit of $250 per member. Family members could also participate.   

According to an indictment filed in the U.S. District Court for the Western District of Missouri, within the first six months of the existence of the Points to Blue wellness program in 2010, member employees of Jackson County and Kansas City, Missouri, began falsifying activity entries on the Points to Blue website by falsely claiming to have completed the most strenuous activities in order to obtain the maximum value gift card or preloaded debit card in the amount of $250. Some members, in addition to making false activity entries to Points to Blue for themselves and their dependents, began soliciting the participation of their co-workers and co-workers’ dependents in Points to Blue by obtaining a co-worker’s identification and login information, so the soliciting member could submit false activity entries on behalf of the co-worker, in exchange for which the soliciting member would keep a portion of the $250 award (usually $50), while the co-worker would receive the remainder.   

The employees altogether received 1,253 gift cards totaling $310,960. Each employee faces a maximum of 60 years in prison and a $750,000 fine if convicted on all counts.