05/13/2010
Nutritional supplement scam touches Regence members in four states
Regence members in Idaho, Oregon, Utah and Washington report that claims for services they never received are showing up on their EOBs.
The scam starts when a member purchases nutritional supplements from one of several companies whose ads state: "Learn how you can get your nutritional supplements reimbursed up to 100% through your insurance provider." The supplement company requests the consumer's Regence member number, claiming that Regence will cover the cost. But the supplements are not, in fact, covered by the member's health plan. The member never receives the products. And the supplement company gets reimbursement from Regence by submitting claims for legitimate, covered services (consultations, lab work and X-rays) that the member never actually received.
The supplement companies advise consumers to disregard any notes on their EOB about the codes for services they didn't receive, claiming that the health plan is attempting to pay less for the services.
We issued a nationwide alert to all Blue Cross and Blue Shield Plans in April after an investigation revealed the scam. The alert affects the nearly 2.5 million members served by Regence and 100 million people nationally who are members of a Blue Cross and/or Blue Shield Plan. This is an ongoing investigation, and we are cooperating with law enforcement.
We are charged with stewardship over our members' resources, including protection against fraud. Charging for services not rendered is one of the most common forms of health care fraud and abuse.
Members are the first line of defense against fraud. That's why we're encouraging them to guard their coverage information. We ask them to examine EOBs as carefully as bank and credit card statements, and report any claims for services, procedures or devices not received.
Have your clients report discrepancies to the Regence Fraud Hotline, 1 (888) 207-4211, or the customer service number on the back of their member card.
Further information is available on our website.
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