Watch for fraudulent prescription and durable medical equipment schemes

Blue Cross Blue Shield of Michigan and Blue Care Network want to make you aware of the escalating prescription schemes that solicit authorizations from prescribers for medications and durable medical equipment that may not be medically necessary for patients. We’ve received complaints from members who have received unwanted medication and supplies.

Some telemarketing companies solicit insurance information and primary care doctors’ contact information from patients through phone calls, emails, social media and online or mail surveys. These companies will then fax prescriptions to the prescriber’s office to obtain his or her authorization. Other times, pharmacies may call requesting authorization from the prescriber to change a medication to a different formulation (for example, extended release or controlled release versus immediate release).

Once the faxed authorization is received, the member begins receiving mailed deliveries of medications or durable medical equipment supplies. Typically, the members’ efforts to contact the pharmacy or DME company to end the shipments aren’t successful.

How to avoid the faxed prescription scheme
Blue Cross urges you to be vigilant about prescriptions received through fax from pharmacies indicating that the patient has requested the medication or needs an authorization for refill. Pay attention to fax or phone requests for the following types of prescriptions:

• Topical applications (lidocaine, doxepin, fluocinonide, calcipotriene, diclofenac, triamcinolone)
• Acid reflux or GERD medication (omeprazole-sodium bicarbonate)
• Diabetic supplies, blood glucose meters, alcohol pads, test strips, lancet devices, control solutions and lancets
• Nasal sprays (dihydroergotamine)
• Non-steroidal anti-inflammatory drugs (naproxen CR/ER, mefenamic acid, fenoprofen calcium)

Red flags

• The faxed prescription may already be completed or offer check boxes for the prescriber to fill out.
• Prescriptions will often request three to five medications, sometimes labeled as a “kit.”
• Beware of requesting pharmacies or DME suppliers that are located out of state. Many times, the prescription will be associated with a pharmacy or DME supplier that you and your patient haven’t had any previous interaction with.
• The prescription will usually request high quantities of medications. Requests for topical applications usually range between 180 to 1,000 grams. Requests for oral dosage forms will typically be enough for a 90-day supply.

Targeted medications frequently change. Carefully review any prescription that your office did not initiate. If you aren’t sure that the patient requested the medication, please do not approve the request. And be especially cautious about requests for topical applications and low- or moderate-intensity pain relievers.