Wayward Prescriptions: Costs of Fraud in Payor Plans

The cost of prescription drugs and medical devices has increased dramatically over the past several years. This increase has exceeded the annual average inflation index, making medical products desired sources of ill-gotten financial gains through diversion, theft, fraud, and deceit. With databases often being compromised, personal health information, personal identification, and therapy history are all available to be used by thieves through deception and misrepresentation, and are being traded on clandestine websites. With increasing values of medical services, wanted efforts continue to emerge in profiteering schemes, using illicit deals for financial gains by exploiting what was once perceived as sacred areas of medical care. Estimates of healthcare resource costs in dollars, lives, and products exceed $200 billion. Select examples of fraud in our medical services are presented that expose plan members to the risks of loss and theft that can compromise the privacy of their health records. The author outlines prevention steps for payors to guard against such practices.