Last Updated: Jun 1, 2017
Highmark has identified a scam in which fraudulent prescriptions are being faxed to physicians. Telemarketing companies are first reaching out to members to obtain their primary care physician's contact information and then faxing prescriptions to their physician's office to obtain authorization.
The Pennsylvania Medical Society (PAMED) has also heard from member practices who have received suspicious faxed prescriptions. Physicians and practices should be on the lookout for any prescriptions they did not initiate—not just for Highmark members but for patients who have health insurance coverage with other insurers as well.
In a May 17, 2017, news update, Highmark said it became aware of the scam after it began hearing from members who had received unwanted large quantities of medications and supplies. The fraudulent prescriptions/requests could include (but are not limited to):
- Compound creams, scar and skin creams, and topical pain creams
- Diabetic supplies
- Braces, including knee, neck, back, or wrist
- Acid reflux or GERD medication
- Non-steroidal anti-inflammatory drugs
These red flags could signal that you've received a fraudulent prescription:
- The prescription or certificate of medical necessity (CMN) will already be completed, including the number of refills.
- The quantity of the medication will be high.
- The requesting pharmacy will usually be out of state.
- The prescription could list multiple options
If you receive a suspicious prescription for a Highmark member that your office didn't initiate, you can contact the Highmark Fraud Hotline at 1-800-438-2478 or fax the prescription to 717-635-4590.
Practices also have the option to report instances of fraudulent prescriptions to the Pennsylvania Attorney General's Bureau of Consumer Protection. Visit the Bureau of Consumer Protection's website for an online complaint form.
You can view Highmark's bulletin via its Provider Resource Center on Navinet to get more details on their investigation of the prescription scam.
PAMED members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.