Fraud, Waste, and Abuse

* Member Alert: Pharmacy/Medical Supplies Call Scam

BCBSAZ Advantage has become aware that some members are being solicited by pharmacies for medications or supplies (e.g. for diabetes) they may not need. See this link to the Inspector General’s office press release about this scam: https://www.oig.hhs.gov/newsroom/news-releases/2012/alert20120309.asp

Example of Fraudulent Call

A caller will reach out to you and offer you help with your pain, diabetic supplies, other medical prescriptions or durable medical equipment. The caller may state that the prescription or supplies will be sent at a low cost or at no cost to you. The caller seems to know you, has your information, and agrees to reach out to your physician to gain the necessary prescription. Regardless of your decision to buy or not buy the medicine or supply, it appears that the caller sends a template prescription form to your physician to get his or her signature and approval to fill.

Once the prescription is returned to the pharmacy, some members report that the requested medication or supplies do not arrive, the medication is in larger quantities than expected, or they did not agree to receive the medication or supplies, but the product arrives on their doorstep.

To Avoid Being a Victim by This Scam

The Better Business Bureau suggests:

  • Never share your Medicare Identification number or other private information with anyone who calls you.
  • If you do NOT know the pharmacy or caller, hang up. Please refer to this article for more information: http://www.argusobserver.com/business/beware-of-intimidating-medicare-scams/article_a8a6bbaa-bbb1-11e5-acf6-6341cb3cb869.html
  • Contact your primary care provider (PCP) or specialist to discuss if you should switch to the new pharmacy.
  • If you receive supplies that you did NOT order, refuse delivery if possible and do not open the box. Contact the BCBSAZ Advantage member services team toll-free at 1-800-446-8331 (TTY/TDD users should call 711) to report the issue. Ask for the claim to be reversed and directions on how to return the unwanted product.

Ask Questions and Understand How Your Benefits Could Be Affected

If you consider changing pharmacies in response to an unsolicited call, here are some questions you may want to ask:

  • What is your name and call back number?
  • How did you receive my name and information?
  • What is the total cost of prescription and my copay?
    • Sometimes your cost share may be low but the actual cost could be thousands of dollars, which might move you towards the prescription drug coverage Gap Stage. Often called the “donut hole,” this could cause you to pay more for all your prescriptions during this phase.

If you want to report potential fraud, waste, or abuse in a BCBSAZ Advantage system, please use the following email address: AZBlueAdvantageSIUMailbox@azbluemedicare.com.

View previous member alerts.

Examples of fraud and abuse

  • Fraud:
  • Altering claims to obtain higher payments
  • Soliciting, offering or receiving a kickback, bribe or rebate
  • Using another person's Medicare card to obtain medical care
  • Abuse:
  • Prescriptions for services that are not medically necessary
  • Billing for a multiple dose medication vial but used for a single dose on one patient
  • Physical health or mental health services that are not medically necessary
  • Ordering labs and test that are not medically necessary

How do I report concerns?

BCBSAZ Advantage takes allegations of Medicare fraud and abuse very seriously. If you think you have been a victim of Medicare fraud or abuse, please use the following phone number to report your concern.

Member Services at BCBSAZ Advantage

  • 1-800-446-8331; TTY hearing impaired users call 711
    Hours of operation
  • October 1 – February 14: 7 days a week, 8:00 a.m. – 8:00 p.m.
  • February 15 – September 30: Monday – Friday, 8:00 a.m. – 8:00 p.m.

How to report directly to CMS

Report anonymously using BCBSAZ Advantage ComplyLine

1-855-729-9719

  • Please leave enough information for us to investigate your concern.

Report by email: AZBlueAdvantageSIU@azbluemedicare.com

Confidentiality

Every effort will be made to protect the identity of the reporting party. There will be no retaliation for good faith reporting.

How do I protect myself?

  • Always check your explanation of benefits to make sure you received the services listed.
  • Never give out personal information, which includes a social security number, Medicare identification number, or BCBSAZ Advantage identification number to callers.
  • Shred documents that contain your personal information.
  • Report any concerns to BCBSAZ Advantage.
  • Educate yourself about how to avoid being a victim.

Where can I learn more?



H0302_1410_2018 CMS Approved 04/20/2018