April 18, 2019
Members are reporting a recent scheme where they’re receiving unsolicited calls asking if they have pain and if they’d like to receive free medical supplies. They’ve received boxes of medications or devices without their doctor’s knowledge or prescription. The health plan is then billed, and the member receives an explanation of benefits (EOB) for the supplies.
How does the scam work?
People are prompted to take a survey on the phone, in a store, or on social media. The survey may ask about pain, other medical information, and name of the user’s auto insurance and health plan. Sometimes the scammers call to tell people their health plan will send them free pain medicine or medical supplies and ask for a member ID or primary physician name.
When the scheme is successful, the health plan is charged by the company and pharmacy for medicines or equipment. The member may receive medicines or supplies or simply receive an EOB showing significant charges.
Where can I learn more?
Read more about this insurance scam and check our Fraud and Abuse page to learn how to identify scams, protect yourself, and report anything of concern to you or your patients.