NJ: Horizon BCBS notifies members that perps posing as doctors stole their insurance information

Sometimes criminals steal  identity information or insurance information to defraud insurers. But while we’ve seen doctors using patients’ insurance information to defraud insurers, it’s a bit unusual to hear that criminals actually posed as doctors to gain access to insurance information that they then used in insurance fraud. That seems to be what happened in this case, though, as this statement from Horizon Blue Cross Blue Shield of New Jersey indicates:

Horizon Blue Cross Blue Shield of New Jersey has always been committed to detecting and combatting health care fraud. On July 30, 2015, we learned that some of our members’ personal information may have been accessed due to fraudulent activity.

Horizon BCBSNJ’s Special Investigations Unit discovered that several perpetrators falsely established themselves as doctors or other health care professionals and obtained Horizon BCBSNJ member identification (ID) numbers, and potentially other personal information, through methods typically only available to legitimate doctors and health care professionals. The perpetrators then submitted false claims to Horizon BCBSNJ using some of the member ID numbers in order to be reimbursed for medical services that were never provided. Horizon BCBSNJ immediately notified the FBI of this fraudulent activity and has been working with the FBI and the U.S. Attorney’s Office.

Horizon BCBSNJ has confirmed that the personal information that may have been accessed by the perpetrators included name, date of birth, gender and member ID number. No Social Security Numbers, financial information or medical information was accessed or disclosed.

If your member ID number was used to submit fraudulent claims or your address was potentially accessed, Horizon BCBSNJ’s Special Investigations Unit would have already called you.

Horizon BCBSNJ has no reason to believe that the personal information obtained was used for any purposes beyond submitting false claims by these specific perpetrators. The information accessed can only specifically be used to submit claims to Horizon BCBSNJ. Horizon BCBSNJ began sending letters to affected members on September 25, 2015.

We deeply regret any inconvenience this incident may have caused. Horizon BCBSNJ has established a dedicated call center for members to call with any questions. If you believe you are affected but have not received a letter by October 5, 2015, please call 1-855-447-4755, Monday through Thursday, between 8 a.m. and 5 p.m., Eastern Time (ET) and Friday between 9 a.m. and 5 p.m., ET.

Our Special Investigations Unit continues to enhance its analytics capabilities, which has allowed Horizon BCBSNJ to be more intuitive in its anti-fraud efforts and better at detecting and stopping fraud in its early stages. Horizon BCBSNJ is continuously evaluating and enhancing internal controls to identify and stop health care fraud and to protect your information. As always, you should review your Explanation of Benefits (EOB) statements and medical bills and report any suspicious activity to Horizon BCBSNJ.

SOURCE: Horizon Blue Cross Blue Shield of New Jersey

Paul Milo of NJ.com reports that at least 1,100 members are being notified.

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