By Dr. Maria Simbra

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PITTSBURGH (KDKA) — Over the holidays, Diane Depalma got a surprise in the mail.

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“I received a box. I put it aside because I thought it was Christmas stuff,” she says. “When I opened it, it was all this lidocaine, it was spray that was like Bioflex, or Biofreeze spray, and two liquids that are like an anti-inflammatory.”

She didn’t know why she received it. Then she got a call from the fraud division of Highmark.

“She told me the expense of the medication that they sent to me was $6,000,” she said.

(Photo Credit: KDKA)

It’s a medical scam that’s sweeping the country.

Surveys pop up in social media feeds, asking about pain and other medical history and personal information.

“Name, phone number, address, in some cases insurance information. What’s their insurance number, who’s their carrier?” Kurt Spear, of Highmark, said. “They’re offering gift cards for people if they fill out the surveys.”

“I went to get a gift card from a department store, and I was entering the information and then they started asking me personal questions. My age, my gender, my car insurance, then they started asking medical history,” Depalma said.

Scammers then get a hold of the information, and the next thing you know, they’re calling the people who’ve taken the surveys, often times stating they work for Highmark.

“[They say] they’re with Blue Cross and Blue Shield, or potentially another insurer, and start to gain the trust of the individuals,” Spear said, “asking them if they’d like to receive free pain creams, diabetic supplies, braces, orthotics.”

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Through a complex network of complicit pharmacies and telemedicine doctors, you could end up with boxes of unneeded and overpriced medical supplies billed to your insurance company.

“They might bill a pain cream that’s typically $20 or $30, they might bill it for $1,200 or $1,500, make significant money, and then provide kickbacks to the pharmacies and the doctors,” Spear said.

And all of this without a doctor’s evaluation. In the case of the creams, there could be drug interactions. In the case of orthotics and braces, they may not even fit.

“They’ll get a shoulder brace and it could be a XXL for somebody who weighs 80 pounds. It’s never going to fit them,” Spear said.

And it’s not just seniors who are falling for this.

“We’ve seen it really across the board, across all ages, across all geographies,” Spear said.

Dr. Maria Simbra: “How many people have been affected by this?”
Spear: “Because it’s an ongoing investigation, we can’t say exactly. I can say there’s been numerous individuals across western Pennsylvania.”

Insurance companies are now working with local, state, and federal authorities. So far, they’ve arrested four people.

“We’ve had over 60 pharmacies on a national level that we’ve identified as being suspect,” Spear said.

As for Diane – she’s not responsible for the products she received, nor is she in any trouble. But she still feels victimized.

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“Exploited, very angry, taken advantage of,” Depalma said. “Insurance costs are high to begin with, but those indirect costs on pulling a scam like that only increases the cost of insurance for people, and people that can’t afford it.”