How to recognize and defeat the scam

A new prescription scam is targeting healthcare providers nationwide. Claiming to operate on a patient’s behalf, pharmacies submit faxes to provider offices requesting new prescriptions or refills for medications not previously ordered.

Fraudulent requests may arrive on pre-printed forms and list several medications. They are liable to be from a pharmacy in a state different from the one in which the patient lives, and they are written for amounts just below the threshold requiring preauthorization.

Requests commonly target:

  • Topical pain-relief creams, especially for large quantities
  • Over-the-counter topical pain-relief creams repackaged in kits
  • Diabetic supplies, often in quantities of 100
  • Durable medical equipment (DME), especially back and knee braces

Here’s what you can do to thwart this fraud:

  • Pay special attention to faxed prescription requests and to requests you know you didn’t initiate.
  • Before signing and returning a prescription request, review and reconcile the request with the patient’s medical record.
  • Share this information with your staff.
  • If you are not a primary care provider (PCP), encourage patients to discuss their prescriptions with their PCP. Urge them to report unsolicited phone calls or communications related to pharmaceutical or DME products.
  • Report fraud. Call or email Humana’s Fraud Hotline immediately if you suspect that you or your patients may be victims of health insurance fraud.

This one-page flyer, PDF opens new window describes the scam and countermeasures.