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Health Care Fraud Can Be Costly To Employers

06/13/13

  05:12:45 am, by MedBen5   , 248 words,  
Categories: News, Health Plan Management

Health Care Fraud Can Be Costly To Employers

Taken together, the leading causes of medical fraud cost employers $4.93 per member per year in unnecessary payments, according to a new study by Truven Health Analytics. Employee Benefit News listed the six most common factors that drive fraud in American health care:

  1. Schedule II drugs without physician care. ($84.3 million) Truven says more than 20% of patients that received drugs such as Morphine, Ritalin or Oxycodone had no medical visit within 90 days of the receipt of prescription.
  2. Multiple patient visits. ($18.5 million) Some 1.4% of “new patient visits” broke American Medical Association guidelines that they occur only once every three years.
  3. Improper use of diabetic supplies. ($8 million) While only $3.9 million in 2010, the cost of diabetic supplies for non-diabetic patients has more than doubled in two years.
  4. Unbundled psychotherapy/drug management services. ($5.3 million) The two are supposed to be billed together using a code that includes both.
  5. Refills on schedule II drugs. ($5.2 million) Although refills are prohibited by law, nearly 1% of patients on schedule II drugs got one.
  6. Wasteful medical transportation. ($1.3 million) More than 5% of patients and 4.6% of medical transport costs had no associated medical visit.

At MedBen, we combat these and other practices through our Anti-fraud Unit, which reviews questionable claims and other related information. This team works in tandem with an advanced surveillance system that thoroughly reviews every claim for fraud potential.

If you’d like to learn more about the measure we take to protect our clients, contact Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

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