More than a thousand Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) members are being notified that access may have been gained to their personal information, and nearly 60 are being alerted that their data was used to submit false claims.
How many victims? False claims were submitted for 58 members, and 1,115 members are being notified that access may have been gained to their personal information.
What type of personal information? Names, dates of birth, genders and member ID numbers.
What happened? Several individuals fraudulently posed as doctors or other health care professionals, gained access to the personal information, and used the personal information to submit false claims to Horizon BCBSNJ.
What was the response? The FBI and United States Attorney's Office were notified and an investigation is ongoing. Members whose personal information was used to submit false claims have had their accounts adjusted. All affected members are being notified, and offered free credit monitoring for two years.
Details: The Horizon BCBSNJ Special Investigations Unit uncovered the scheme on July 30. The perpetrators posed as doctors or other health care providers and submitted false claims using member ID numbers in order to be reimbursed for medical services that were never provided. The suspects gained access to the member ID numbers and potentially other personal information through methods typically only available to legitimate doctors and health care professionals.
Quote: “Horizon BCBSNJ has no reason to believe that the personal information obtained was used for any purposes beyond submitting false claims by these specific perpetrators,” an alert posted to the Horizon BCBSNJ website said. “The information accessed can only specifically be used to submit claims to Horizon BCBSNJ.”
Source: A Horizon BCBSNJ spokesperson emailed a release to SCMagazine.com on Tuesday; horizonblue.com, “Notice of Fraud Activity Affecting Horizon Blue Cross Blue Shield of New Jersey,” Sept. 25.