Analysis Details Wasteful, Fraudulent Claims Paid by Employers
New analysis of commercial insurance claims for 11.6 million individuals and dependents at 150 large employers finds six types of fraudulent or wasteful claims result in $122.6 million in annual overpayments.
New analysis of commercial insurance claims for 11.6 million individuals and dependents at 150 large employers finds six types of fraudulent or wasteful claims result in $122.6 million in annual overpayments.
These claims cost employers $4.93 per member per year in unnecessary payments, according to study author Truven Health Analytics. The causes and costs for the studied employers:
* More than 20 percent of patients receiving Schedule II drugs had no associated medical care for 90 days prior to getting the prescription, at a cost of $84.3 million. These drugs include Vicodin, Oxycodone, Cocaine, Morphine and Ritalin, among others.
* Almost one percent of patients prescribed Schedule II prescriptions get a refill, which is prohibited under federal law, costing $5.2 million.
* Inappropriate visits labeled “new patient” visits cost $18.5 million annually.
* Improper distribution of diabetic supplies costs $8 million, with 7.4 percent of patients getting such supplies having no diagnosis of diabetes.
* Unbundled psychotherapy and drug management services, which should be billed together, cost $5.3 million.
* Nearly five percent of medical transport costs had no associated medical visit, costing $1.3 million.
The study is available here, registration is required.
These claims cost employers $4.93 per member per year in unnecessary payments, according to study author Truven Health Analytics. The causes and costs for the studied employers:
* More than 20 percent of patients receiving Schedule II drugs had no associated medical care for 90 days prior to getting the prescription, at a cost of $84.3 million. These drugs include Vicodin, Oxycodone, Cocaine, Morphine and Ritalin, among others.
* Almost one percent of patients prescribed Schedule II prescriptions get a refill, which is prohibited under federal law, costing $5.2 million.
* Inappropriate visits labeled “new patient” visits cost $18.5 million annually.
* Improper distribution of diabetic supplies costs $8 million, with 7.4 percent of patients getting such supplies having no diagnosis of diabetes.
* Unbundled psychotherapy and drug management services, which should be billed together, cost $5.3 million.
* Nearly five percent of medical transport costs had no associated medical visit, costing $1.3 million.
The study is available here, registration is required.
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