Monday, February 21, 2011
Increase in Rx dispensing partial cause of fraud increase?
Once they realize they only can get so much Oxycontin at one pharmacy they turn to other pharmacies. This brings us to our next factor to look for, multiple pharmacy locations. In previous pharmacy records canvasses we have found claimants that have used up to 8 different pharmacies all within a 20 mile radius of their home. There are several ways a claimant will try to reproduce their prescription but in the end the desperate find a way. The most difficult obstacle the claimant must overcome are the larger pharmacies with area networks that enable them to view prescriptions from other locations. The thing that most people forget is that there are more smaller pharmacies than you think, as well as the vast numbers of larger pharmacies available.
The last factor to look for in possible Oxycontin addicted claimants are repeat offender claims whether for the same injury or same employer. Or if the claimant has multiple claims all with a record of doctor prescribed pain killer use. The "professional" claimant now fakes, stages or lies about injury just so they will be able to get the next dose of prescriptions. The claimant may appear to cooperate and return to work in a timely manor but it is the frequency of claims that adjusters must be aware of.
By using medical records canvases not only can you find the possibility of pre existing conditions but there are certain situations where you will uncover more. The increase in prescribed pain killers and the addictive nature of those prescriptions opens the WC claims to other dangers that you may have never thought of. The use of pharmacy medical records canvasing can bring to light a hidden agenda of your claimant that you may have overlooked otherwise.
Posted by National SIU