Medical and Prescription Fraud

CALL (646) 820-9202


by: Tehila Mörtl

 

With the high cost of medical care coverage, medication and insurance members of our society can hardly afford necessary expenses without becoming the victims of fraud.  To avoid becoming a victim, it is important to become familiar with the types of schemes and how they are committed. 

 

Health Care and Health Insurance Frauds

Medical Equipment Fraud:

Anyone who has watched television or read a magazine are no doubt familiar with the countless offers for products for free trial.  The problem with these are that once the trial period is over, consumers are charged an exorbitant fee.  Similarly companies offering free medical equipment might not bill the patient directly but does bill their health insurance for equipment the individual does not actually need or has never received.

Rolling Lab Schemes:

Rolling labs are represented as mobile medical labs typically found at the likes of health clubs, shopping malls or even retirement homes.  Through these labs patients receive unnecessary and at times fake tests for which insurance companies or Medicare is billed. 

Insurance and Medicare Fraud:

Such frauds are committed when a provider or insured submits a claim for service or goods not received.  Elders are often targets of Medicare schemes by medical equipment manufacturers, etc. because once the medical provider’s signature is obtained the company can in turn bill the insurance company or Medicare.

Tips for avoiding health insurance and Medicare fraud:

  • Do not sign blank insurance claim forms.
  • Never give extended authorization to a medical provider to bill for services rendered.
  • Always ask medical providers and medical goods companies for an itemized list of charges including out-of-pocket fees and insurance charges.
  • Carefully review insurer’s explanation of the benefits statement.  Address any questions you might have to insurer and provider.
  • Only provide your insurance and/or Medicare identification to those who have provided you with a service.
  • Do not make transactions with telephone or door-to-door individuals offering free medical equipment.
  • Keep accurate records of health care appointments and medical equipment orders.

Tips for Avoiding Counterfeit Prescription Drugs:

  • When refilling a prescription or ordering from another source, check appearance.
  • Examine packaging and lot numbers of medications, remaining alert to changes from one prescription to the next.  Advise pharmacist if medication looks suspicious.
  • Advise your pharmacist and physician immediately if you experience adverse side effects or your condition does not improve.
  • Never purchase prescriptions from unlicensed online distributors or any business selling medications without a prescription. 

Remain cautious when purchasing your prescriptions on the internet.  Never order medications from unlicensed on-line distributors or anyone offering medications without a legal prescription.  Reputable on-line pharmacies carry the seal of approval called the Verified Internet Pharmacy Practice Site (VIPPS), provided by the Association of Boards of Pharmacy in the United States.

Prescription Club Scam

Given the number of elders taking multiple medications this is one of the more clever scams.  This type of prescription service requires a membership fee and purportedly offers discount rates on medication.  However, the victim loses his or her money by the time they learn that no such club exists.  

Fraudulent online pharmacies

While the idea of ordering prescriptions online is inviting and far less hassle than driving to the pharmacy every month, one must remain vigilante to ensure the medication they are receiving is legal, legitimate and not contaminated or fake.  Granted there are legitimate U.S. pharmaceutical companies both on-line and in stores throughout the country by purchasing medication from those not so reputable run the risk of medication which has been mislabeled, counterfeit, adulterated, contaminated of questionable quality and stored improperly.  In short, the risks simply are not worth the so-called savings. 

How to spot illegal online pharmacies

  • Does not require a prescription from a licensed physician
  • Are not concerned with your medical history
  • Do not specifically state payment, privacy and shipping fees clearly on site
  • Does not utilize encrypted or secure website transactions

Be aware that most legitimate pharmacies are also certified by the National Association of Boards of Pharmacy.  Should you come across a questionable online pharmacy services, please contact your local FBI office immediately

Should you have questions or need assistance with securing services, please feel welcome and encouraged to call Advise & Protect to talk with one of our experienced and compassionate senior care consultants.  We have the experience t/o assist with securing any service you might need.  For those who would like to share their own experiences of an elder’s passing, please contact us directly.

If you are in need of help with senior care, elder law, moving for seniors, estate management, medical equipment, planning after life services, etc. please do not hesitate to call Advise & Protect Senior Care Consultants at 646-820-9202 so that we may aid in meeting your needs!


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