Did you know : that healthcare fraud estimates in the United States exceed $68 billion annually?
Did you know : that when differentiating fraud from waste and abuse, the distinctions are intent and benefit?
Did you know : that what you interpret as a mistake may be pursued as fraud based upon a pattern of your behavior?
RJ Health’s Clinical Informatics Pharmacist, Laura Benson (PharmD, RPh), has produced an excellent primer on Fraud, Waste, Abuse, and Avoidance, Specific to Medical Drug Claims. This is a diverse topic that spans all parties involved in the delivery and payment of healthcare services.
Benson divides this primer into three distinct parts:
Part 1: Reviews fraud, waste, and abuse including estimated U.S. volume, definitions, investigative bodies, and potential impact. Compliance issues specific to the medical drug claim are introduced.
Part 2: Narrows the topic specific to medically administered drug claims, with compliance monitoring suggestions for providers.
Part 3: Discusses leveraging data external to standard claim fields to identify and monitor for claim outliers with suggestions for implementation.