Prescription Insurance Fraud Cases

One of the biggest causes of prescription insurance fraud is that many doctors and pharmacists are "gaming" the system to obtain better pay for their services. According to a survey of 750 physicians, many of them admitted to fraudulent service billing. Counterfeit medicines are also promoted unknowingly throughout the supply chain, which results in recalls and FDA alerts. But, by taking proactive measures, these problems can be avoided and the overall costs to payors can be minimized.

Health insurance companies collaborate with law enforcement and other agencies to identify and investigate cases of fraudulent practice. Since these fraudsters target the healthcare system, they are prosecuted aggressively. If you've been accused of prescription fraud, contact an experienced attorney immediately. Moreover, keep in mind that this type of fraud is often very hard to detect, especially if you're a doctor. The process of obtaining a conviction is complex, so it's advisable to seek the advice of an attorney who has extensive experience in prescription fraud.

Prescription Insurance Fraud Cases Top List

The Affordable Care Act was passed in 2009, increasing scrutiny on health care practices. The goal was to curb cost inflation by squeezing out waste and fraud. The result has been an increase in costs for all parties involved: health insurance companies, hospitals, doctors, and the government. As a result, the cases of prescription insurance fraud are becoming more prevalent and severe. To combat this issue, healthcare companies are partnering with law enforcement and putting together a comprehensive strategy.

Using medical claims analysis to detect prescription insurance fraud is an important first step. By reviewing the details of medical claims, insurers are able to identify questionable practices and identify individuals who are abusing their benefits. For instance, if a patient's physician writes 10 controlled substance prescriptions in a three-month period, or visits three different doctors or pharmacies, Blue Cross Blue Shield Plans will issue a warning letter. In addition, the plans will assign a case manager to the patient to help differentiate between legitimate pain management and abuse.

There are many signs of prescription fraud in health plans. The insurer may flag a patient's medication for excessive or questionable purposes by monitoring his or her medical history. When this happens, the insurer will issue a warning notice. In addition, a patient may receive three different prescriptions for the same controlled substance in three months. If the patient has a history of abuse, a doctor might be unable to detect it.

Some patients may not be aware of the fact that their medical bills may be illegally overcharged. In such cases, a patient should contact the medical society or county Board of Pharmacy. The Board does not have the authority to investigate a patient's medical bills. For example, a physician can be charged with felony prescription fraud if he has a record of dishonest billing. The same holds true if he or she is found guilty of abusing a health insurance plan.

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