A medical scam on a national scale could raise the costs of health insurance

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PITTSBURGH (KDKA) – During the holidays, Diane Depalma had a surprise in the mail.

"I received a box. I put it aside because I thought it was Christmas, "she says. "When I opened it, it was all that lidocaine, it was a spray that looked like Bioflex or Biofreeze, and two liquids that are like an anti-inflammatory."

She did not know why she was receiving him. She then received a call from the Highmark Fraud Division.

"She told me that the cost of the drugs they sent me was $ 6,000," she said.

(Photo credit: KDKA)

It is a medical scam that sweeps across the country.

Surveys appear in social media, dealing with pain, medical history and personal information.

"Name, phone number, address, in some cases, insurance information. What is their insurance number, who is their carrier? Said Kurt Spear of Highmark. "They offer gift cards to people who fill in the polls."

"I went to get a gift card from a department store and I grabbed the information and started asking myself personal questions. My age, my sex, my car insurance, and then they started asking for a medical history, "said Depalma.

Fraudsters then get information and, as soon as you know it, they call the people who participated in the polls, often indicating that they work for Highmark.

"[They say] they are at Blue Cross and Blue Shield, or perhaps another insurer, and are starting to gain the confidence of individuals, "Spear said," asking them if they would like to receive free pain creams, supplies for diabetics, orthoses, orthoses. "

Thanks to a complex network of complicit pharmacies and doctors in telemedicine, you could end up with unnecessary and overpriced medical supplies cartons billed to your insurance company.

"They could charge a pain cream that usually costs $ 20 or $ 30, a $ 1,200 or $ 1,500 bill, make a lot of money, then bribe pharmacies and doctors," said Spear.

And all without the evaluation of a doctor. In the case of creams, there may be drug interactions. In the case of orthotics and orthopedic appliances, they may not even match.

"They will have one shoulder and it could be an XXL for someone who weighs 80 pounds. It will never do, "said Spear.

And it's not just seniors who fear for it.

"We have seen it at all levels, at all ages and in all geographic regions," Spear said.

Dr. Maria Simbra: "How many people have been affected by this?"
Lance: "As this is an ongoing investigation, we can not say exactly. I can say there have been many people in western Pennsylvania. "

Insurance companies now work with local, provincial and federal authorities. Until now, they have arrested four people.

"We had more than 60 pharmacies nationally that we identified as suspicious," said Spear.

As for Diane, she is not responsible for the products she has received and she has no problem. But she still feels victim.

"Exploited, very angry, we took advantage," said Depalma. "The costs of insurance are high first, but the indirect costs of such a scam only increase the cost of insurance for people, and for people who can not afford to insure themselves. pay."