On April 20, UC filed suit in Los Angeles County Superior Court to stop what appears to be a fraud resulting in improper payments of nearly $12 million from UC's Student Health Insurance Plan (SHIP). This fraud involved contacting UC students — sometimes with offers of employment or offers of cash to participate in sham “clinical trials” — to obtain their insurance information. Students were then prescribed unnecessary medications that were charged to the health plan. 

Related Links

UC SHIP is conducting an in-depth, ongoing investigation with UC’s legal counsel and cooperating with law enforcement. In the meantime, UC is taking every reasonable step to protect our students, faculty, staff and retirees, and our medical plans, from this kind of abuse. While UC is researching whether this fraud has extended to members of UC’s plans for faculty, staff and retirees, UC’s self-insured PPO plans are taking two immediate precautionary measures:

  • Prescriptions costing over $3,000 will require a prior authorization form, completed by the provider and approved by the plan.
  • Prescriptions written by the same providers or filling pharmacies, or for certain types of drugs, that were identified in the SHIP claims will be denied, pending an appeal from the member to confirm the prescription is appropriate.

These are likely to be temporary measures while UC determines the full impact of the issue. Unfortunately, however, these controls may still impact entirely appropriate prescriptions. If members have any problems filling medically necessary prescriptions, they should call their plan’s prescription drug customer service number for assistance. UC will assess the continuing need for these measures as the investigation progresses.

Protect yourself from insurance fraud

This situation is an unfortunate reminder of the importance of safeguarding all personal information, including your health insurance ID. Here are a few suggestions for protecting yourself from insurance fraud:

  • Never provide your health insurance ID or Social Security number to someone you don’t know, and avoid sharing sensitive information over email or through social media. 
  • Be wary if someone offers you “free” health services or products, but requires you to provide your health plan ID number. Medical identity thieves may pretend to work for an insurance company, doctors’ office, clinic, or pharmacy to try to trick you into revealing sensitive information ... and then use that information to commit insurance fraud.
  • Keep paper and electronic copies of your medical and health insurance records in a safe place. Shred outdated health insurance forms, prescription and physician statements, and the labels from prescription bottles before you throw them out.
  • Before you provide sensitive personal information to a website that asks for your Social Security number, insurance account numbers, or details about your health, find out why the information is needed, how it will be kept safe, whether it will be shared, and with whom. If you decide to share your information online, first read the privacy policy on the website and look for a lock icon on the browser’s status bar or a URL that begins “https:” the “s” is for secure.

Finally, UC runs many clinical trials, and they are absolutely essential to ensuring the advancement of medicine. A genuine clinical trial, however, has important protections for its enrollees, and will rarely offer large sums of money to participants (and never simply for signing up or attending a single visit). To make sure a clinical trial is legitimate before you participate or share any personal information:

  • Contact the Institutional Review Board, or Ethics Committee, associated with the study. This information should be listed on the informed consent form you are asked to sign.
  • Search for the study on clinicaltrials.gov.