Alert Notices:

Fraud Alert: Suspect Charges Billed by Non-Participating Applied Behavior Analysis (ABA) Providers

Posted: June 9, 2026

Be wary of suspect charges and services from non-participating ABA providers. Red flags that could indicate improper billing behavior include:

• Unusual Promises: A provider guarantees immediate treatment or implies no out-of-pocket costs, regardless of your plan benefits.
• Excessive Billing: Your EOB shows an unusually high number of ABA therapy hours or exorbitant charges that seem disproportionate to services received.
• Unfamiliar Provider: You receive an EOB for services rendered by an ABA provider you do not recognize or have never visited.
• Services Not Received: Your EOB lists services or dates of service for ABA therapy that you or your dependent did not actually receive.

Please call to report any suspect fraudulent activity by calling or emailing FIPR.

Notice of Data Incident  | BRG

Posted: April 3, 2026

Berkely Research Group (“BRG”), a firm that provides consulting, advisory and legal support servicers to Express Scripts, a business associate and pharmacy benefit management vendor to Highmark, reported a data security event impacting Highmark members.

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DME Fraud Statement/Sales Alert

Posted: November 5, 2025

Highmark is aware of a current nationwide scam targeting insurers and Highmark members where fraudulent companies are attempting to submit claims for Durable Medical Equipment (DME) such as catheters or braces that were never provided.

These companies are randomly submitting hundreds of claims across the country hoping an insurer will pay them. Highmark is actively working to catch and deny these claims as part of our fraud prevention process. However, members are encouraged to review Explanation of Benefit and billing statements for any charges that appear suspicious or are for services that were not received.

Members who believe they were charged for a fraudulent service, and whose Explanation of Benefit does not indicate a denied claim, should contact Highmark’s fraud prevention team at 1-800-438-2478.       

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