April Fraud Fridays – 3 Tips to Prevent Health Care Fraud

By Jessica Johnson, SIU Clinical Consultant, Prime Therapeutics

April 7, 2023

Prime Therapeutics’ (Prime) Special Investigations Unit (SIU) has watched fraud trends evolve. We recently shared the latest trend on off-label use of GLP-1 drugs – such as Ozempic®, Victoza®, and Mounjaro® – for off-label uses, including weight loss, driven by social media.

And while we could exhaust countless blog posts tracking these schemes for our members to learn about, as the saying goes, “the best defense is a good offense.” Which is why for the month of April, the SIU team will present “Fraud Fridays” across Prime’s social channels and this blog. The goal is simple – to provide members with the information, tips and guidance to protect themselves from a variety of fraud schemes.

We’ll start with some very general tips you can use to protect your data.

In today’s app-driven world, we are constantly sharing our data. From our entertainment preferences to our shoe size, much of the data we share on apps or social media is fairly benign. However, with an increasing number of apps we use each day that enable us to interact with health providers and more, people are storing a significant amount of private information online, which may increase the likelihood of fraud.

But there are some very simple things you can do, including:

  1. Review your explanation of benefits and health insurance bills. Always read the fine print and have a basic knowledge of your health plan coverage. Contact your health plan to learn more, or if you spot concerns, report them.
  2. Protect your member I.D. card and personal information. Also, protect your private data and use caution when you provide information online. You can be easily compromised by including details such as your location, previous educational institutions, or other identifying information online or over the phone.
  3. Take control of your care. Be your own best advocate and speak up. You have the right to manage your healthcare. But you also can request medical records and billing information at any time.

These tips are just the start, and if you would like to know more to protect you and your family, we will have more information for you next week, and look for more on Twitter @Prime_PBM.


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