Go figure: fraud data

 

Drug diversion

Insurance fraud is a major financier of America’s epidemic diversion of addictive prescription drugs such as OxyContin, according to Prescription for Peril, a December 2007 report by the Coalition Against Insurance Fraud.

1. Drug diversion costs health insurers up to $72.5 billion a year in bogus claims involving opioid abuse alone;

1. Private health insurers lose up to $24.9 billion annually;

1. Diversion costs individual private insurance plans up to $857 million annually;

1. Nearly half of Aetna’s member/pharmacy anti-fraud team’s caseload involved prescription benefits in 2006;

1. Expenses of suspected doctor-shopping members of Medco Health Solutions were nearly seven times higher than the monthly cost of members without excessive prescription claims; and

1. Abuse suspects incurred $41 in claims for office visits and outpatient treatment for every $1 in narcotic prescription claims against WellPoint.