Understanding Patient Scams: Lessons from a Primary Care Practice

Hello everyone! My name is Brad, and welcome back to the blog. As a primary care provider with a practice serving over 21,000 patients, I have nothing but love for the vast majority of my patients. However, today, I want to shed light on a challenging but important topic: scams. Specifically, I’ll discuss the scams I’ve encountered in my practice, how they impact medical providers, and tips for spotting and preventing them. While my focus is on healthcare, many of these lessons apply to any business owner.

Scams During the Pandemic

The first scam dates back to the early days of the COVID-19 pandemic, a time when masks and gloves were in short supply. A new patient booked an appointment for a COVID test and, after being tested, left under the guise of needing to attend to work. Later, we discovered he had stolen a significant portion of our masks and gloves, cramming them into his backpack before leaving. This incident left us scrambling to maintain supplies for our other patients and staff.

Red Flags: PO Boxes and Identity Concerns

Over time, I’ve noticed a pattern: patients providing a PO Box as their address are often linked to scams. While this isn’t always the case, in an urban area like ours, it’s unusual for someone’s primary address to be a PO Box. Common scams associated with these patients include:

1. Insurance Fraud: Patients may claim identity theft to avoid providing an ID. One notable case involved a woman who posed as an executive for Blue Cross Blue Shield. She refused to provide her ID, citing past identity theft. It turned out she was using her sister’s insurance, leading to the insurance company reclaiming the funds from our practice.
2. Check Fraud: Fraudulent checks are another common tactic. These often look like temporary checks issued when opening a new bank account. Such checks are frequently flagged as fraudulent, causing significant financial and administrative headaches.
3. Credit Card Chargebacks: Patients have also disputed legitimate charges by claiming their credit card was stolen. To counter this, we now include terms of service requiring patients to acknowledge that their medical notes may be shared with their credit card company if a chargeback dispute arises.

Prescription Fraud

A particularly concerning scam involves fraudulent prescriptions. Some individuals, armed with a provider’s NPI number, attempt to call or fax pharmacies to issue fake prescriptions. In one case, a patient repeatedly called in prescriptions for controlled substances under my name. Fortunately, they used their real name to pick up the medication, enabling law enforcement to catch them in a sting operation.

Another time, Walmart alerted us to a faxed prescription that misspelled “Codeine”—a red flag. Since we don’t fax prescriptions, this alerted us to the fraud. In Texas, updated laws now require electronic prescriptions for controlled substances, adding an extra layer of protection.

Lessons Learned and Best Practices

Scams like these are rare, but they’re a reality of running any business. Here are some steps we’ve taken to mitigate these risks:

1. Require Valid Identification: We now mandate two forms of ID from all patients, even if one is partially obscured for privacy.
2. Verify Payment Methods: Checks are deposited immediately, and we require manager approval for accepting any checks. We’ve also strengthened our policies to counter credit card chargebacks.
3. Stay Alert to Patterns: PO Boxes, unusual payment methods, and overly defensive behavior about providing personal information are all potential warning signs.
4. Collaborate with Law Enforcement: When fraud occurs, especially involving prescriptions, we report it promptly. Impersonating a physician is a felony, and we take it seriously.

Final Thoughts

Out of 21,000 patients, these incidents are thankfully rare. However, they serve as a reminder to remain vigilant. Whether you own a medical practice or another type of business, staying informed and proactive can help protect your operations and ensure you can continue serving your clients or patients effectively.

Thank you for reading, and I hope these stories provide some helpful insights. If you’ve encountered similar challenges, feel free to share your experiences in the comments below!