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.
- Phone 1-800-614-4126
- Email email@example.com.
, PDF opens new window describes the scam and countermeasures.