Regence recognized with Anti-Fraud Award for Stopping Drug Diversion in the Northwest
BlueWorks program honors excellence in Blue Cross and Blue Shield plans nationally
Quick action on a tip, plus interagency cooperation, helped earn Regence BlueCross BlueShield recognition among Blue plans nationwide for a successful fraud investigation that can be duplicated across the country.
Their proactive investigation took specific steps to protect members, find the culprit, prevent further abuse of Medicare funds and halt the illegal drug diversion:
Found the common link: the identification cards presented to pharmacies around Portland belonged to a Regence Medicare prescription plan specific to the Seattle area
Identified and called members with this specific plan whose accounts showed recently processed claims for prescription narcotic medication
Notified members that their ID might be compromised and issued them new IDs
Identified the common factor among these members, an eye clinic they all visited
Examined employee records of the eye clinic to develop a list of those who fit description of woman photographed passing narcotics prescriptions
Notified Health Integrity MEDIC, and later the U.S.Health and Human Services Office of the Inspector General (HHS-OIG) of this ongoing investigation, as required under federal law.
The Regence affiliated companies serve more than two million members through Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (selected counties in Washington). Each health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. The Regence affiliated companies are committed to improving the health of its members and communities and to transforming the health care system. For more information, please visit www.regence.com or follow us on Twitter.