Warning to Providers About Fraudulent Prescription Scam

Highmark’s Financial Investigations and Provider Review unit has been made aware of a new scam involving fraudulent prescriptions being faxed to physicians. We’ve received complaints from Highmark members who have received unwanted large quantities of medications and supplies. These complaints prompted us to conduct numerous investigations into these suspected fraudulent prescriptions.

We've learned that telemarketing companies are contacting members and obtaining their primary care physician's contact information. Then, the companies fax prescriptions to the physician’s office to obtain his or her authorization.

How to avoid the faxed prescription scheme

Highmark urges you to pay attention to any prescriptions or certificates of medical necessity (CMN) received through fax from pharmacies or suppliers indicating that the patient has requested the medication or supplies. Be on the alert for the following types of requests:

• Acid reflux or GERD medication (omeprazole sodium bicarbonate)
• Braces – knee, neck, back, or wrist
• Compound creams
• Diabetic supplies, blood glucose meters, alcohol pads, test strips, lancet devices, control solutions, and lancets
• Non-steroidal anti-inflammatory drugs such as mefenamic acid or fenoprofen calcium
• Scar and skin creams (Urevaz or fluocinonide)
• TENS units and associated supplies, such as electrodes, leads, and batteries
• Topical pain creams (lidocaine, diclofenac sodium, Vanatol LQ, and combination packs)
• Vitamins

Red Flags

• The prescription or CMN typically will be completed with the medication or supplies and SIG (label or directions) already filled in, including the number of refills.
• The quantity of the medication will be high. Most ointments, gels, and creams are dispensed in grams. Most tubes and jars come in sizes of 35.4, 50, or 100 gram sizes. The questionable prescriptions could list the quantity anywhere from 248 to 744 grams.
• The requesting pharmacy will usually be out of state.
• The prescription could list multiple options in categories such as topical pain therapy; wellness; scar or dermatitis; eczema; general or diabetic neuropathy; inflammatory pain; arthritis; acid reflux; or GERD.

The list of medications can change. Please review any prescription carefully that your office did not initiate. If you are not sure that the patient actually requested the medication, please do not approve the request.