Still in Sarasota, FL visiting my parents and almost dropped my teeth at a story Dad told me last night. See what you think.
Several years ago, Dad began receiving materials about heart health from the local pharmacy, part of a national chain. He tossed them; in his mid-70s, Dad’s heart was going strong (still is!) and the information was about drugs he had never taken.
A few months later, for record keeping purposes, Dad requested and received a list of all the drugs he had purchased from that same pharmacy. As he looked over the list, he found references to many drugs he knew he had never been prescribed, had never had any need to take — all heart related — including coumadin and others.
OK — so that explained why he had been receiving those health intelligence materials — presumably a nice service from the pharmacy.
But — ding ding ding!! Alarm alarm alarm! Why on earth were those heart drugs listed on Dad’s account? Who did they belong to? And who had paid for them? Going back a few years, the total cost had been almost $20,000! Because Dad has an excellent prescription plan through his pre-retirement, self-insured employer, it was that employer who had paid all that money.
Dad contacted the administrators of his prescription insurance group which, as mentioned above, were people within the company he retired from (because they were self-insured. Large corporations often are.) They sent security personnel to Florida to investigate. Afterall, it appeared that someone had fraudulently obtained prescription drugs at the expense of Dad’s company.
Dad only knows part of the rest of the story…. turns out there was a man who lived in Tampa with his same name. The man’s prescriptions had all been phoned in to another branch of the same pharmacy chain and their accounts had become mixed up within the pharmacy’s computers. The man’s wife had been picking up the prescriptions, paying the copay — Dad doesn’t know whether she knew the accounts were mixed up or not. She may have been completely unaware, or she may have realized they had a good thing going and continued to capitalize on it. Afterall, the drugs were costing her only $3 copay. $20,000 later, one can only hope that at least her husband’s heart was still going strong.
The story is interesting from a number of angles — but it set off some alarms to me that had less to do with the possible fraud, and more to do with Dad’s safety and medical identity theft.
Safety: so suppose Dad had been in Tampa for some reason, and had taken sick. Suppose the had been rushed to a Tampa hospital. Is it possible the records from the pharmacy about his drugs could have gotten mixed up with his real records? What if he wasn’t conscious… would they have given him some of those heart drugs? I don’t know the answers. I’m just throwing out the questions.
ID Theft: so suppose Dad hadn’t been so interested in his history of purchases from the pharmacy. Would that same person have continued to purchase drugs through Dad’s insurance? Would there be a history somewhere that Dad had heart disease because those drugs were on his records? Suppose he had then been turned down for a co-insurance program somewhere else, or that his company would have been defrauded further? Could that person have also been able to obtain Dad’s insurance account numbers, and from there, social security numbers or other identification that could have then turned into identity theft?
The questions remain, but they are a good reminder to all of us….
Every step along the way of our health transactions, we need to double check that the care and drugs and other treatments we need or receive are ours, and ours alone. When you visit the doctor’s office, ask to review your records to be sure they all belong to you. When you pick up a prescription at the pharmacy, ask to review the list of drugs they have on file for you to be sure they are all drugs you’ve been prescribed. And make sure they match up at least your birthdate in addition to your name. If you have a common name, be even more diligent.
Fraud, or mistakes? Intentional or accidental? When it comes to our health, and the overall ramifications of identity errors, we can’t ever be too careful.
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