Hiding in Plain Sight
Pharmacy Fraud, Waste, and Abuse in Workers’ Compensation
A doctor writes the prescription. A pharmacy fills the prescription. A patient gets the prescription. This straightforward process takes place every day, and most prescriptions are filled without issue and follow all the appropriate pricing and dispensing rules.
Sometimes though, the rules are not followed:
- A pharmacy dispenses a higher-priced medication NDC when lower-cost NDC options are available.
- A physician dispenses Lidocaine 4% patches at a much higher volume than local peers.
- A patient fills multiple prescriptions from multiple doctors at multiple pharmacies.
Whether purposefully or accidentally, these could be cases of medication fraud, waste, or abuse (FWA), which can lead to higher costs, medication misuse, and legal prosecution. Plus, in workers’ compensation claims, the injured worker may never question the cost of a prescription because they are not paying for it, so the FWA just remains hidden within your claims.
All this heightens the urgency to identify, analyze, and correct FWA at the pharmacy, physician, and injured worker level.
Download the latest MyMatrixx article for more information on the clinical and financial impact of FWA and the solution that can help correct it.
