Consumers, including Medicare beneficiaries, advised to be on alert
BOSTON, Oct. 19, 2022 /PRNewswire/ -- Blue Cross Blue Shield of Massachusetts (Blue Cross) is cautioning members to be vigilant, as scams offering free durable medical equipment (DME) and pharmacy products are on the rise.
"While these types of scams have been around for years, the uptick in telemedicine usage during the COVID-19 pandemic is causing a resurgence in fraud," said Jennifer Stewart, senior director for fraud investigation and prevention at Blue Cross Blue Shield of Massachusetts.
Medicare beneficiaries and patients who've had a recent injury or surgery are often targeted by scammers. In many cases, the perpetrators solicit physicians to sign off on unnecessary orders or prescriptions, such as back braces or pain cream, which are then improperly billed to a patient's health insurer.
Avoiding Fraud
Medical equipment and pharmacy products that are not properly prescribed to patients are potentially dangerous, said Stewart. In fact, some may not even be authorized by the FDA.
"Members should treat their medical information like their credit card number and if they're unsure, they should call their clinician to confirm if a service or product is necessary," Stewart noted. She also recommends reviewing medical statements carefully to ensure accuracy and reporting any discrepancies.
For Clinicians and Health Plans
Clinicians should encourage patients to report any suspicious activity to Medicare, their health plan, and law enforcement, explained Stewart.
"With any health care scam, everyone pays the price – whether you know it or not," added Martin Flood, senior investigator for fraud investigation and prevention at Blue Cross. "In addition to the financial consequences, these scams have the potential to jeopardize patient health and result in long-term complications. It's everyone's job to be more vigilant."
Monitoring for Fraud
Stewart emphasized that Blue Cross' fraud departments work together to monitor claims for suspected fraud and alert government agencies if needed. "Once we start shutting down these claims and not paying them, these fraudulent organizations disappear quickly. However, they typically move on to new targets which proves that we all need to remain vigilant," said Stewart.
Reporting Suspected Fraud
Blue Cross members who suspect, experience or witness health care fraud should report the information by calling the number on the back of their member identification card. Consumers who are not Blue Cross members can call the company's fraud reporting hotline at 1-877-327-BLUE (2583). Federal employees and retirees can report potential health care fraud by calling 1-800-337-8440.
About Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of Massachusetts (http://www.bluecrossma.org) is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We are committed to the relentless pursuit of quality, affordable and equitable health care with an unparalleled consumer experience. Consistent with our promise to always put our members first, we are rated among the nation's best health plans for member satisfaction and quality. Connect with us on Facebook, Twitter, YouTube, and LinkedIn.
SOURCE Blue Cross Blue Shield of Massachusetts
