Tips to prevent pharmacy fraud

Guard against pharmacy fraud with these tips

I like old movies and when a good classic is on, I have been known to stay up well past my bedtime to see the end – even though I have likely seen the end more than once.

Not long ago, I was catching a classic movie on a channel that still runs commercials. Generally, I tune out or change the channel, but this commercial caught my attention. The announcer, in his best TV announcer voice, asked the question, “Do you suffer from arthritis pain?” The commercial went on to say you could get prescription-strength medications “at no cost to you.” This piqued my curiosity. After all, I have arthritis in my knees; I am a pharmacist and I work for Blue Cross and Blue Shield of Kansas. “How can they do this?” I asked myself, knowing full well there had to be a catch.

I had to investigate. I called the number on the screen and the representative asked me about my arthritis, where it was, how long I have suffered, etc. Then came the questions about whether I had insurance and my identification numbers. There was the hook! This was not going to be free. They were going to bill my insurance but not charge me any co-payment. That is when I hung up. After all, the commercials were over and the movie was back on.

All of us are familiar with financial identity theft. Criminals obtain social security and credit card numbers, bank account information and start racking up fraudulent charges. Well, medical identity theft is also very real. According to a 2014 Consumer Reports study, it costs the economy an estimated $41.3 billion per year.

The numbers on your insurance cards are just as valuable and vulnerable as those on your credit cards. They can be shared and sold by criminals to get medical services, prescription drugs and medical equipment under your name, just like the criminal that buys a big screen TV with a stolen credit card number.

Consumers need to do their part to decrease medical and prescription fraud. Here are some simple, but very important, rules:

  • Be stingy with your personal health and insurance information. Just like your credit card information, do not share them with people you don’t know.
  • Read the Explanation of Benefits (EOB) letters you receive from the insurance company as if they were bank or credit card statements. Check them for accuracy and question any charges that are unfamiliar.
  • Read statements and correspondence from all health care providers and pharmacies for accuracy and question any services you don’t recognize.
  • Immediately contact the customer service number on the back of your insurance card if you suspect there are questionable activities on any of the information you receive from providers or the insurance company.

In my job with BCBSKS, I see how fraud impacts the health delivery system. I don’t know if my brief encounter with the TV pharmacy would lead to criminal activity, but I do know this offer seemed too good to be true. I knew nothing about the pharmacy, and sharing my personal and health information and ultimately my insurance information was not worth the “free” services they were promising.

Ken Mishler, BCBSKS corporate pharmacist

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