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Fraud, Waste & Abuse (FWA) Management

Fraud, Waste & Abuse (FWA) Management

Abstract

The USA is currently undergoing an epidemic of prescription drug fraud and abuse that is estimated to be as high as $22 billion and which extends to both public and private programs. Due to the rapid growth of the problem the industry, government and law enforcement have been overwhelmed and have been in a defensive mode. It is imperative therefore, that a paradigm change that includes both pro-active analysis for new claims as well as retrospective trending be used. Find out how HCL is helping the stakeholders tackle the issue with new information technology and strategies. 
 
Excerpts from the Paper
 
It is no surprise that fraud and abuse in prescription drug programs has exploded. In a recent report, epidemiologists at the Centers for Disease Control and Prevention concluded that “the prescription drug problem is a crisis that is steadily worsening.” Backing this view are statistics showing that drug-related deaths increased 96% from 2005-2010, with most of the jump due to prescribed pain medications versus “harder” drugs like heroin or cocaine. The technical challenge of sifting through the resulting mountains of data for signs of suspicious behavior is formidable, and it is one that has overwhelmed healthcare companies and law enforcement agencies alike. In addition, the healthcare reform landscape itself could offer potential opportunities to increase fraud and abuse.

 

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