Under what condition can an insurance company refuse to pay for a prescription with a fraudulent identification card?

An insurance company can refuse to pay for a prescription when the pharmacy has been notified that the identification card is canceled. This underscores the importance of the validity of the insurance identification card. When an insurance card is canceled, it implies that the coverage associated with that card is no longer active, and therefore, the insurance company is within its rights to deny claims related to that card.

In the context of pharmacy operations, being informed about the cancellation alerts the pharmacy to the potential risks of processing claims for individuals who may be attempting to use fraudulent or expired credentials. The focus here is on the insurance company's obligation to uphold its policies and to protect against fraudulent practices.