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The Insurance Fraud Tactic

Insurance fraud is using someone’s health insurance card (posing as the insured person) to pay for treatment.

Tactic

The drug seeker will locate someone who has a job that provides health insurance who is desperate for money. The drug seeker will offer to pay the person ($500.00 to $600.00 per month) for the use of their insurance card. Once they obtain the card, they will purchase a fake/counterfeit driver’s license or identification card. The fake driver’s license or identification card will display the drug seekers photo and the insured person’s information i.e. name, address, D.O.B., etc.

The professional drug seeker realizes that receptionists will likely not attempt to verify or question the authenticity of the driver’s license or identification card. The drug seeker will use one insurance card per clinic so they cannot be traced by the insurance company or Prescription Drug Monitoring Program. Primary tools:

  • Fake ID or Driver’s License;
  • Using someone else’s insurance card; and
  • Use different identity at each clinic.

Once this drug seeker is accepted by the clinic, they:

  • Will not miss an appointment;
  • Will not call in early for refills;
  • Will participate in treatment program;
  • Will attempt to fit in;
  • Will not draw attention to themselves; and
  • Will attempt to remain in the clinic for years.

Selecting Clinics

  1. Will avoid clinics they believe may be investigated.
    • Will look for strength; and
    • Professional appearance.
  2. Enforced opioid/patient agreements.
  3. Will avoid clinics who request laboratory conformations for urine drug tests. The drug seeker can pass a point of care drug test by taking one capsule/tablet the night before their appointment. The drug seeker does not want to take up to five days of the medication in order to pass a laboratory conformation.
  4. Will avoid clinics who requests pill counts. The drug seeker does not want to hold back pills to be counted. They want to sell the pills on the street.

Flags

The drug seeker:

  • Will likely present a fake/counterfeit DL or ID upon new patient intake.
  • Will avoid being photographed.

Safeguards

  1. Verify all DLs or IDs presented by new patients upon intake.
  2. Complete a comprehensive risk assessment.
  3. Photograph all new patients.
  4. Request random pill counts.
  5. Provide random urine testing. Assess lab conformations.
  6. Pay attention to the subconscious verbal and non-verbal cues presented by the patient.

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