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Horizon BCBS NJAll Plans · Administrative · Provider News · NJHigh impact

Watch Out for the DME Telemarketing Scheme

Act
immediately
Effective date
Not stated in the notice
Identified
Oct 3, 2026

Summary

Horizon Blue has issued a fraud alert warning providers about DME telemarketing schemes involving unnecessary equipment (urinary catheters, glucose monitors, COVID tests, orthotic braces, wound care supplies). Telemarketers illegally solicit referrals without established patient relationships, misuse provider NPIs, and violate state licensure requirements. Providers must implement protective measures including NPI safeguarding, claims monitoring, and employment opportunity vetting to avoid compliance violations and fraud liability.

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What to do

immediately · 5 steps
01Billing team must implement enhanced claims monitoring procedures to detect unauthorized DME referrals billed under the practice's NPI—compare all submitted claims against provider documentation and referral records.
02Providers must verify that all DME orders have documented established patient relationships before authorizing any referrals, per New Jersey Board of Medical Examiners regulations and state licensure requirements.
03All providers must secure NPI numbers and prescription pads in locked storage; do not share NPIs with outside telemarketing entities.
04Front office staff must flag any unsolicited employment offers involving phone-based DME referrals or questionnaire-based prescribing—providers must check state regulations before accepting such opportunities.
05If unauthorized claims or NPI misuse is suspected, report immediately to Horizon Blue fraud hotline at 1-800-624-2048 and document all findings.
If missed: Failure to implement these controls exposes the practice to federal fraud prosecution, claim recoupment, and loss of provider status.

Original notice

Watch Out for the DME Telemarketing Scheme
horizonblue.com · Always check the source before changing claims.
View original ↗

Related changes

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