Data Analysis Aid the Feds in Medical D Violations

data analysis

Data gathering is perhaps one of today’s most useful processes. And similar to all things useful there will be entities out there who will use it for illicit activities. Given that this is the case, the procedure is still quite the tool for a lot of people who are using it legally.

Businesses, for instance, heavily benefits from this method as this are among their major instruments in determining the ebb and flow of their market. Government agencies are also leveraging data gathering to help track down criminal activities that would otherwise be flying under the radar.

But in order for an organization to benefit from it they also need another process that goes hand in hand with data gathering.

Data Analysis

A mountain of data is useless if one cannot decompile, analyze, and find patterns from the collected information. So what does data analysis mean, exactly?

To put it shortly, data analysis is the process of sifting, cleaning, transforming, and modeling data in order to find trails and conclusion to a certain goal. The result of this process then helps businesses and organizations draft and create solutions to a particular problem.

Violation of Medicare Part D

Data gathering and data analysis has been the key in the recent arrests involving the violation of Medicare Part D, a U.S. federal- government program created for Medicare beneficiaries to subsidize prescription drug costs and prescription drug insurance premium.

Annual spending of drug prescriptions under the plan has been estimated to reach $121 billion. But the program has been exploited in several different ways:

  • People reselling prescription drugs
  • Double doctoring to receive more prescriptions
  • Giving kickbacks to physicians to write more prescriptions
  • Pharmacies providing drugs without required prescriptions
  • Identity theft of legitimately covered patients for illegal distribution

After the Office of the General analyzed the data they were able to hone in on hot spots where the frauds are occurring.

The OIG reported over 700 physicians has been found prescribing high amount of drugs that has a huge potential for abuse. Pharmacies that were identified had been filling prescriptions without a doctor’s orders, and even filling prescriptions for deceased patients. The report also found that non-medical doctors, such as massage and physical therapists, were also providing prescriptions to patients with pharmacies honoring the prescriptions.

The drugs that are primarily being prescribed are highly addictive opioid which is causing an epidemic of overdoses across the U.S.

Affecting the Good Guys

With the rise of all these fraud cases those that have been staying in line is also going to be affected. Marbry Young, a worker at Hope Intervention Inc. providing mental health care to patients, has expressed her concern over the intensive investigation by the federal authorities.

“Once there is a big investigation for fraud, then that means more paperwork for us who are doing our best to stay in compliance,” Young said. “As time goes on, I see us doing more paperwork than servicing customers.”

And the investigation will only get bigger as data are revealing vast number of pharmacies that are violating Medicare Part D. The feds are making a statement with all these audits and arrests to people who are involve, and right now their resources are being deployed to dig deeper into the matter.

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