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Watch Out for the DME Telemarketing Scheme
Act
immediately
Effective date
Not stated in the notice
Identified
Oct 3, 2026
Summary
This is a fraud alert regarding telemarketing schemes involving DME products (urinary catheters, glucose monitoring supplies, COVID-19 tests, orthotic braces, wound care supplies). Telemarketers cold-call beneficiaries, submit questionnaires to providers for signature, and bill for unnecessary or non-dispensed DME. Providers must implement safeguards to protect NPI numbers, monitor claims, secure prescription pads, and avoid employment arrangements involving phone-based patient referrals for DME.
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What to do
immediately · 7 steps
01All providers and billing staff must implement the following safeguards.
02Billing team must monitor all claims and reimbursements submitted under the practice's NPI number to ensure they match actual billings submitted by the practice.
03Providers must verify they have an established provider-patient relationship before signing any DME prescription orders, per NJ Board of Medical Examiners regulations.
04Front office staff must secure all physical prescription pads in locked cabinets or safes when not in use.
05IT/compliance staff must protect electronic records and patient data from unauthorized access to prevent fraudster access to beneficiary information.
06Providers must not pursue employment or referral arrangements involving DME telemarketing, phone-based patient solicitation, or questionnaire-based prescribing without first consulting state regulations and compliance counsel.
07If any unauthorized claims, suspicious referral offers, or potential fraud is detected, report immediately to Horizon Blue Cross Blue Shield fraud hotline at 1-800-624-2048.
If missed: Failure to implement these controls may result in fraudulent claim submission under the practice's credentials, liability for reimbursement of false claims, and regulatory sanctions.
Original notice
Watch Out for the DME Telemarketing Scheme
horizonblue.com · Always check the source before changing claims.