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(Kens 5 San Antonio)   Why computers are awesome: Medicare inspectors were able to uncover $5.6 billion in potential fraud by running a statistical analysis on all 1 billion prescriptions filled at retail pharmacies that were billed to Medicare last year   (kens5.com) divider line 77
    More: Interesting, medicare, statistical analysis, data analysis, generic drugs, prescription costs, doughnut hole, pharmacy, strip malls  
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3526 clicks; posted to Geek » on 10 May 2012 at 11:35 AM (2 years ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2012-05-10 09:38:50 AM  
It's better than nothing, but that $5.6 billion is already out the door and good luck getting it back. And what little is recovered...goes right back into Medicare where it can be stolen again.

Medicare does not require the private insurers that deliver prescription benefits to seniors to report suspicious billing patterns.

That's so profoundly stupid it can only be there by design.

Overall, only a small fraction of retail pharmacies - 4.4 percent - were found to have telltale patterns of questionable billings.

One out of every 23 is small?

I wonder how many businesses would survive with a mentality of "well, only one out of 23 employees is stealing us blind. No biggy."

Nationally, independent pharmacies were more likely to have problems than chain drugstores.

Probably because those "independent pharmacies" were nothing more than storefronts.

"The program has limited safeguards in place and is vulnerable to fraud, waste and abuse," the report said.

This is not a headline from 30 years ago.
 
2012-05-10 09:41:58 AM  
They are using this approach across the board. They just put away a guy for food stamp fraud here in Minneapolis that was discovered using this technique.
 
2012-05-10 10:04:52 AM  

That's so profoundly stupid it can only be there by design.


This is how people feel about you.
 
2012-05-10 10:19:26 AM  
Gulper Eel

you realize that medicare's overhead (overhead includes fraud, operating costs, profit taking, etc) as a % of it's budget is around 4% ... the private insurers are around 30%
 
2012-05-10 10:45:27 AM  

Kazan: Gulper Eel

you realize that medicare's overhead (overhead includes fraud, operating costs, profit taking, etc) as a % of it's budget is around 4% ... the private insurers are around 30%


Math. You fail at it.

TFA clearly states that this particular facet of Medicare shows an observed "questionable payment" rate of ten and a half percent. ($5.6b divided by $53b - I'm assuming the writers are comparing 2009 to 2009).

So that's ten and a half percent...even before this program examines what other prescription spending might have been redundant or wasteful.

Other examinations of Medicare and Medicaid show similar and far higher levels of straight-up fraud, along with waste and duplication - and pushback from the hospital industry when actual oversight is done.

Additionally, private insurers 'higher' overhead is money spent to ensure that they're NOT doing what Washington does - namely, throwing money around to placate (mainly elderly) voters without bothering to check whether it went to a legitimate provider until the money's been spent.

In other words, citations needed (and from somebody without skin in the game).
 
2012-05-10 10:56:30 AM  

Gulper Eel: Kazan: Gulper Eel

you realize that medicare's overhead (overhead includes fraud, operating costs, profit taking, etc) as a % of it's budget is around 4% ... the private insurers are around 30%

Math. You fail at it.

TFA clearly states that this particular facet of Medicare shows an observed "questionable payment" rate of ten and a half percent. ($5.6b divided by $53b - I'm assuming the writers are comparing 2009 to 2009).

So that's ten and a half percent...even before this program examines what other prescription spending might have been redundant or wasteful.

Other examinations of Medicare and Medicaid show similar and far higher levels of straight-up fraud, along with waste and duplication - and pushback from the hospital industry when actual oversight is done.


ENTIRE PROGRAM VS ONE PART... farking hell.. and your nytimes citation talks about ny's state level medicare.

Gulper Eel: Additionally, private insurers 'higher' overhead is money spent to ensure that they're NOT doing what Washington does - namely, throwing money around to placate (mainly elderly) voters without bothering to check whether it went to a legitimate provider until the money's been spent.

buuuuuuuuuuuuuuulshiat


it goes into their goddamn pockets

politifact has a write up on when boxer made the claim and found it to be largely true Link
 
2012-05-10 11:03:47 AM  

NowhereMon: They are using this approach across the board. They just put away a guy for food stamp fraud here in Minneapolis that was discovered using this technique.


My employer sells analytics software (amongst othe rthings), and they decided that it would be a very cool idea to test them on our internal expence claims. There are apparently lots of people who had very hard questions to answer after the first test runs. For example, it seems the mileage from base offices to various customer locations varies by up to 500% depending on who's driving.
 
2012-05-10 11:15:09 AM  

Gulper Eel: Medicare does not require the private insurers that deliver prescription benefits to seniors to report suspicious billing patterns.

That's so profoundly stupid it can only be there by design.


Requiring private insurers that deliver prescription benefits to seniors to report suspicious billing patterns is business killing government regulation. Why do you hate jobs?
 
2012-05-10 11:16:51 AM  
Why computers statistical analysis is awesome

FTFY subby.

Computers are just a tool.
 
2012-05-10 11:20:24 AM  

Gulper Eel: Additionally, private insurers 'higher' overhead is money spent to ensure that they're NOT doing what Washington does - namely, throwing money around to placate (mainly elderly) voters without bothering to check whether it went to a legitimate provider until the money's been spent.


WRONG. some of it goes into actual fraud prevention, but the bulk goes into shareholder profits.

For example: United Health Group:
Revenues: $101,862,000
- Medical costs: $74,332,000
- Operating costs: $15,557,000
- Cost of products sold: $2,385,000
- Depreciation: $1,124,000
--------------------------------------
Earnings (before taxes): $8,464,000

The operating costs was only 15% of their total revenues, and that includes paying the bills and salaries. Fraud prevention is a minute portion of that.
 
2012-05-10 11:21:46 AM  
Numbers above are in thousands.
 
2012-05-10 11:25:16 AM  

Kazan: politifact has a write up on when boxer made the claim and found it to be largely true Link


Yes, I read that true. It's an interesting world you live in where "half true" equals "largely true". (and a reading of that article indicates Poltifiact is being charitable)

Additionally, that article shows that your original assertions that private sector overhead is ~30% and that Medicare overhead includes fraud numbers...are both bullshiat.

Thank you for refuting yourself.
 
2012-05-10 11:27:38 AM  

Flab: WRONG. some of it goes into actual fraud prevention, but the bulk goes into shareholder profits.


Profits? Heavens forfend. Where's my faiinting couch?
 
2012-05-10 11:32:12 AM  

Gulper Eel: Profits?


I have nothing against profits, in fact, as an investor, I like companies to make a profit. But you made it sound like the 30% overhead was ALL going towards fraud prevention, and it's clearly not the case.
 
2012-05-10 11:38:10 AM  
Correlation isn't causation.
But it might be fraud.
 
2012-05-10 11:38:53 AM  

Gulper Eel: It's better than nothing, but that $5.6 billion is already out the door and good luck getting it back. And what little is recovered...goes right back into Medicare where it can be stolen again.

Medicare does not require the private insurers that deliver prescription benefits to seniors to report suspicious billing patterns.

That's so profoundly stupid it can only be there by design.

Overall, only a small fraction of retail pharmacies - 4.4 percent - were found to have telltale patterns of questionable billings.

One out of every 23 is small?

I wonder how many businesses would survive with a mentality of "well, only one out of 23 employees is stealing us blind. No biggy."

Nationally, independent pharmacies were more likely to have problems than chain drugstores.

Probably because those "independent pharmacies" were nothing more than storefronts.

"The program has limited safeguards in place and is vulnerable to fraud, waste and abuse," the report said.

This is not a headline from 30 years ago.


I'm really surprised to find you here upset that anti-fraud measures continue to produce results. You'd think with Medicare waste being your pet gripe, this would be welcome news.
 
2012-05-10 11:39:29 AM  

Flab: Gulper Eel: Profits?

I have nothing against profits, in fact, as an investor, I like companies to make a profit. But you made it sound like the 30% overhead was ALL going towards fraud prevention, and it's clearly not the case.


Not my intent, sorry.

It is pretty clear that even a small anti-fraud investment by Medicare would yield huge savings...especially if they stopped the fraud BEFORE the money was gone, for a change.

Unfortunately, Medicare uses this thoroughly silly "pay-and-chase" system where they cut the checks first and ask questions later. We are forever hearing from various government functionaries that pay-and-chase is going to go away, but articles like this one make it pretty clear that it's not going to happen at any serious level any time soon.
 
2012-05-10 11:41:33 AM  

Gulper Eel: It's better than nothing...


Wasn't graft/fraud/etc one of those Teabagger talking points?

Y'know, the whole 'Fixing the Old' bit? Why is that now only 'better than nothing'?
 
2012-05-10 11:47:23 AM  
Good.

The more troubling thing they need to address is the whole "pay the first to bill for one" problem: There are tests / exams / etc that Medicare limits to specific time periods (as in, "can only get x test every y months," say)*, but the first organization to bill for it gets paid.... even if it's poorly done, worthless or misinterpreted. The organization stuck cleaning up after some idiot doctor / RT / whatever and re-doing the test can't bill and often has to eat the cost.

This should be addressed and, further, the DBs should be mined to find the doctors / labs / etc that have abnormally high "do-over by someone else" records and their fees should be reduced and their licenses and procedures inspected.

There's lots of data collected by Medicare. I hope this is just a good first start in mining it to find ways to improve delivery of care.
 
2012-05-10 11:49:52 AM  

Omnivorous: Correlation isn't causation.
But it might be fraud.


This.

The distaffbopper was once accused by a pharmacist of committing fraud. The prescription the doctor had written for the littlebopper was in the name we called him*, but his Medicaid card was to "Boy Doe", he being a foundling that hadn't been officially given a legal name at the time, and also being an indigent ward of the county. The prescription was for an antibiotic commonly used to treat ear infections in infants, which the littlebopper had at the time.

Luckily, a quick phone call to the supervising pharmacist at the place, who knew us and our special circumstances, cleared that up, and the guy apologized.

We also had to go through a bunch of shenanigans to get him a SS# after the adoption.

*And that is now his legal name, since the adoption.
 
2012-05-10 11:50:20 AM  

Gulper Eel: I wonder how many businesses would survive with a mentality of "well, only one out of 23 employees is stealing us blind. No biggy."


Quite a few, actually. Pretty much all the "big box" stores.
 
2012-05-10 11:53:37 AM  

dragonchild: Gulper Eel: I wonder how many businesses would survive with a mentality of "well, only one out of 23 employees is stealing us blind. No biggy."

Quite a few, actually. Pretty much all the "big box" stores.


I'm pretty sure even the dimmest Best Buy floor manager would manage a "what's all this, then?" if one of his underlings was strolling out the door with ten flat-screen TVs.
 
2012-05-10 11:54:19 AM  
Why computers are awesome: Medicare inspectors were able to uncover $5.6 billion in potential fraud by running a statistical analysis on all 1 billion prescriptions filled at retail pharmacies that were billed to Medicare last year.

Also, porn.
 
2012-05-10 11:54:38 AM  

Gulper Eel: It is pretty clear that even a small anti-fraud investment by Medicare would yield huge savings...especially if they stopped the fraud BEFORE the money was gone, for a change.


Agreed. It's very hard to do without taking control of the whole assembly line, though.

Hopefully these new analysis tools will allow them to start rejecting claims as they come in, or at least ask the claimant for additional justification in suspicious cases ("Hm... This Dr. House from New Jersey seems to prescibe a lot of Percocet"), just like banks and phone companies are now doing when they see irregular transaction patterns.
 
2012-05-10 11:59:02 AM  

Gulper Eel: I'm pretty sure even the dimmest Best Buy floor manager would manage a "what's all this, then?" if one of his underlings was strolling out the door with ten flat-screen TVs.


Why the fark does it have to be ten flat screen TVs? Couldn't you have just said, "Hm, hadn't thought of that," instead of roaring out of the gate by taking reductio ad absurdum to derpy extremes?
 
2012-05-10 12:00:32 PM  

dragonchild: Quite a few, actually. Pretty much all the "big box" stores.


I'd say the majority when you look at CEO pay vs company performance.
 
2012-05-10 12:03:37 PM  
Hopefully these new analysis tools will allow them to start rejecting claims as they come in, or at least ask the claimant for additional justification in suspicious cases ("Hm... This Dr. House from New Jersey seems to prescibe a lot of Percocet"), just like banks and phone companies are now doing when they see irregular transaction patterns.

Great.

You of course know the result of this is 10% of claims will be unnecessarily rejected by a computer and the process to get your legit claim 'unrejected' will take 3 weeks and the filling of several forms.
 
2012-05-10 12:10:17 PM  

Gulper Eel: Flab: Gulper Eel: Profits?

I have nothing against profits, in fact, as an investor, I like companies to make a profit. But you made it sound like the 30% overhead was ALL going towards fraud prevention, and it's clearly not the case.

Not my intent, sorry.

It is pretty clear that even a small anti-fraud investment by Medicare would yield huge savings...especially if they stopped the fraud BEFORE the money was gone, for a change.

Unfortunately, Medicare uses this thoroughly silly "pay-and-chase" system where they cut the checks first and ask questions later. We are forever hearing from various government functionaries that pay-and-chase is going to go away, but articles like this one make it pretty clear that it's not going to happen at any serious level any time soon.


"Pay and Chase " will never go away because of another Washington phrase "Constituent services" . Suppose Medicare's analytics discover that it looks like a hospital in Podunk, IL is robbing them blind and so they refuse payment on their invoices. The hospital board (all big contributors to his re-election campaign) contact Congressman Vreeblefester (R-IL) and tell him that these evil government bean counters won't give them their money and the hospital is going to have to shut down most of its services if they don't get paid. Meanwhile the hospital has told its patients that, particularly the elderly and most vulnerable and scared THEM into writing desperate letters to the congresscritter as well.

Well the Congressman fires off an Angry Letter to the HHS administrator (CC'ed to all the concerned folks back home) demanding to know why his home district hospital, a pillar of the community and famed for its sterling integrity, is being so badly misued by the flunkies at HHS. The HHS administrator gives it to his Congressional Coresspondance people and tell them to look into it. This gets all the way back down to the GS-13 or 14 who made the call in the first place, and his boss' boss' boss is telling him he'd got-damned well BETTER be right about this call or his career is over. That's when the HHS aide to the administrator who is also on the conference call suggests a "compromise" where the Gs-13 continues his investigation and tries to make a case the US attorney can make, and in the meantime we cut the check to Podunk Memorial so the Congressman doesn't rip the Departnment a new one in Congressional hearings next week.
 
2012-05-10 12:10:39 PM  
Medicare paid $5.6 billion to 2,600 pharmacies with questionable billings, including a Kansas drugstore that submitted more than 1,000 prescriptions each for two patients in just one year, government investigators have found

You need statistical analysis and computers to tell you that 1000 scripts for one person is off?
 
2012-05-10 12:14:34 PM  

MugzyBrown: Hopefully these new analysis tools will allow them to start rejecting claims as they come in, or at least ask the claimant for additional justification in suspicious cases ("Hm... This Dr. House from New Jersey seems to prescibe a lot of Percocet"), just like banks and phone companies are now doing when they see irregular transaction patterns.

Great.

You of course know the result of this is 10% of claims will be unnecessarily rejected by a computer and the process to get your legit claim 'unrejected' will take 3 weeks and the filling of several forms.


So the alternative is to let fake drug stores abuse the system?

The system doesn't have to deny the claims completely. It can set a temporary limit until the pharmacist can justify why his customers buy 5 times the national average of drug X.
 
2012-05-10 12:14:43 PM  
Potential fraud. Now it needs someone to go and check it by hand, which costs a lot of money when most of the potential fraud turns out to be just atypical.

Or are we in favor of automated lawsuits when it's not the MPAA doing it?
 
2012-05-10 12:15:21 PM  

dragonchild: Gulper Eel: I'm pretty sure even the dimmest Best Buy floor manager would manage a "what's all this, then?" if one of his underlings was strolling out the door with ten flat-screen TVs.

Why the fark does it have to be ten flat screen TVs? Couldn't you have just said, "Hm, hadn't thought of that," instead of roaring out of the gate by taking reductio ad absurdum to derpy extremes?


I'm going to go out on a limb and say that it's because reductio ad absurdum is funny. Which you clearly need a lesson in, given 1) This is Fark 2) See #1
 
2012-05-10 12:15:26 PM  

dragonchild: Gulper Eel: I'm pretty sure even the dimmest Best Buy floor manager would manage a "what's all this, then?" if one of his underlings was strolling out the door with ten flat-screen TVs.

Why the fark does it have to be ten flat screen TVs? Couldn't you have just said, "Hm, hadn't thought of that," instead of roaring out of the gate by taking reductio ad absurdum to derpy extremes?


It's the floor manager who does the stealing.
 
2012-05-10 12:16:10 PM  

dittybopper: Luckily, a quick phone call to the supervising pharmacist at the place, who knew us and our special circumstances, cleared that up, and the guy apologized.


Good thing you weren't at a CVS.......
 
2012-05-10 12:19:08 PM  

Flab: So the alternative is to let fake drug stores abuse the system?

The system doesn't have to deny the claims completely. It can set a temporary limit until the pharmacist can justify why his customers buy 5 times the national average of drug X.


Just pointing out the obvious. have you ever tried to deal with a government agency about an error made?

Talking with people who have no ability to make judgements, but can only check off their list?
 
2012-05-10 12:19:18 PM  
One thing about the cost of drugs I hadn't realized:

They actually have each chemical plant only perform one or two steps of the synthesis at a time. Then they ship it to other plants to go through the rest of the steps. I thought it was basically all done in one location with your basic ingredients (phenols, alcohols, amines, aromatics) turned into a finished product.

When they're shipping the 1,2,3,4,5,6,7,8,9-phenylbenzylarylalylthiodioleneaneone or whatever the fark between plants, it racks up costs like crazy.
 
2012-05-10 12:29:23 PM  

Flab: MugzyBrown: Hopefully these new analysis tools will allow them to start rejecting claims as they come in, or at least ask the claimant for additional justification in suspicious cases ("Hm... This Dr. House from New Jersey seems to prescibe a lot of Percocet"), just like banks and phone companies are now doing when they see irregular transaction patterns.

Great.

You of course know the result of this is 10% of claims will be unnecessarily rejected by a computer and the process to get your legit claim 'unrejected' will take 3 weeks and the filling of several forms.

So the alternative is to let fake drug stores abuse the system?

The system doesn't have to deny the claims completely. It can set a temporary limit until the pharmacist can justify why his customers buy 5 times the national average of drug X.


And if the customer, who legitimately needed that amount of X, dies while "being choked by government bureaucracy"?

Obviously no one wants to be defrauded and no one wants to see anyone die needlessly, but there's a certain urgent time constraint to medical care versus a seven year statute of limitations on fraud -- so yes, I'd rather the fake drug store temporarily abuse the system (and get punished for it later).
 
2012-05-10 12:45:06 PM  

Kazan: Gulper Eel: Kazan: Gulper Eel

you realize that medicare's overhead (overhead includes fraud, operating costs, profit taking, etc) as a % of it's budget is around 4% ... the private insurers are around 30%

Math. You fail at it.

TFA clearly states that this particular facet of Medicare shows an observed "questionable payment" rate of ten and a half percent. ($5.6b divided by $53b - I'm assuming the writers are comparing 2009 to 2009).

So that's ten and a half percent...even before this program examines what other prescription spending might have been redundant or wasteful.

Other examinations of Medicare and Medicaid show similar and far higher levels of straight-up fraud, along with waste and duplication - and pushback from the hospital industry when actual oversight is done.

ENTIRE PROGRAM VS ONE PART... farking hell.. and your nytimes citation talks about ny's state level medicare.

Gulper Eel: Additionally, private insurers 'higher' overhead is money spent to ensure that they're NOT doing what Washington does - namely, throwing money around to placate (mainly elderly) voters without bothering to check whether it went to a legitimate provider until the money's been spent.

buuuuuuuuuuuuuuulshiat


it goes into their goddamn pockets

politifact has a write up on when boxer made the claim and found it to be largely true Link


Wow. You just destroyed him, Kazan. Nicely done!
 
2012-05-10 12:55:56 PM  

Publikwerks: Medicare paid $5.6 billion to 2,600 pharmacies with questionable billings, including a Kansas drugstore that submitted more than 1,000 prescriptions each for two patients in just one year, government investigators have found

You need statistical analysis and computers to tell you that 1000 scripts for one person is off?


Okay, next time I'll hand you a printed list of claim data for all one billion prescriptions and you can do the analysis by hand.
 
2012-05-10 01:01:01 PM  
why computers are not awesome: ONLY 5.6 billion? does no one else think that # is pretty low? the system is incredibly filled with cheats.
 
2012-05-10 01:04:24 PM  

Omnivorous: Correlation isn't causation.


Although if you're looking for causation, correlation is usually a pretty good place to start.
 
2012-05-10 01:06:54 PM  

omnibus_necanda_sunt: One thing about the cost of drugs I hadn't realized:

They actually have each chemical plant only perform one or two steps of the synthesis at a time. Then they ship it to other plants to go through the rest of the steps. I thought it was basically all done in one location with your basic ingredients (phenols, alcohols, amines, aromatics) turned into a finished product.

When they're shipping the 1,2,3,4,5,6,7,8,9-phenylbenzylarylalylthiodioleneaneone or whatever the fark between plants, it racks up costs like crazy.


Still trivial. It costs cents to make the second pill, but billions of dollars to make the first one. Then you have whatever part of your patent is left after getting through approval to make those billions back before Dr. Reddy's starts undercutting you.
 
2012-05-10 01:08:23 PM  

HotWingConspiracy: I'm really surprised to find you here upset that anti-fraud measures continue to produce results. You'd think with Medicare waste being your pet gripe, this would be welcome news.


If Medicare waste gets don't to ridiculously low levels, it gets harder to get rid of medicare under the guise that it is wasteful.
 
2012-05-10 01:08:49 PM  

aharown: ONLY 5.6 billion? does no one else think that # is pretty low? the system is incredibly filled with cheats.


Incredibly filled with cheats because. . . how do you know? Someone told you? Saw it on TV? You know some people who cheat?

Might I recommend a healthy habit? When data and hyperbolic political rhetoric (always heavily flavored with personal anecdotes) don't agree, trust the data. There are no guarantees, as data is easy to manipulate, but odds are the guy in the suit with an agenda screaming about how our world is falling apart is probably not your most reliable source.
 
2012-05-10 01:11:59 PM  

Publikwerks: You need statistical analysis and computers to tell you that 1000 scripts for one person is off?


No, you need statistical analysis and computers to FIND 1000 scripts for one person. Do you think they did that in 1 bulk order?
 
2012-05-10 01:12:06 PM  

omnibus_necanda_sunt: One thing about the cost of drugs I hadn't realized:

They actually have each chemical plant only perform one or two steps of the synthesis at a time. Then they ship it to other plants to go through the rest of the steps. I thought it was basically all done in one location with your basic ingredients (phenols, alcohols, amines, aromatics) turned into a finished product.

When they're shipping the 1,2,3,4,5,6,7,8,9-phenylbenzylarylalylthiodioleneaneone or whatever the fark between plants, it racks up costs like crazy.


THAT STUFF SAVED MY LIFE
 
2012-05-10 01:12:15 PM  

impaler: If Medicare waste gets don't to ridiculously low levels, it gets harder to get rid of medicare under the guise that it is wasteful.


Ah, someone understands the Republican platform.

Here in MA, I still remember how they (Acting Biatch Jane Swift, specifically) gutted welfare. Did I say they gutted welfare? I'm sorry, I meant to say they eliminated -- not gutted, eliminated -- the welfare fraud investigation department.
 
2012-05-10 01:34:53 PM  
i1.kym-cdn.com
 
2012-05-10 01:49:28 PM  
I wonder what the amount of actual fraud was, i.e. false positive rate.
 
2012-05-10 01:55:20 PM  

MusicMakeMyHeadPound: Flab: MugzyBrown: Hopefully these new analysis tools will allow them to start rejecting claims as they come in, or at least ask the claimant for additional justification in suspicious cases ("Hm... This Dr. House from New Jersey seems to prescibe a lot of Percocet"), just like banks and phone companies are now doing when they see irregular transaction patterns.

Great.

You of course know the result of this is 10% of claims will be unnecessarily rejected by a computer and the process to get your legit claim 'unrejected' will take 3 weeks and the filling of several forms.

So the alternative is to let fake drug stores abuse the system?

The system doesn't have to deny the claims completely. It can set a temporary limit until the pharmacist can justify why his customers buy 5 times the national average of drug X.

And if the customer, who legitimately needed that amount of X, dies while "being choked by government bureaucracy"?

Obviously no one wants to be defrauded and no one wants to see anyone die needlessly, but there's a certain urgent time constraint to medical care versus a seven year statute of limitations on fraud -- so yes, I'd rather the fake drug store temporarily abuse the system (and get punished for it later).


There's no need to completely deny the payment requests, but maybe tell the drug store that it must include copies of the prescriptions with the claims, until it can justify why it sells 5 times more drug X than the other stores in its area. There may be a good reason (ex: it's next to a free STD screening clinic, so it's normal that it would sell more Valtrex than your regular neighborhood CVS).

[CSB]
When I went on my honeymoon, I called both VISA and MC to see if there were problems with using them in Eastern Europe. One of the two said "Thanks for letting us know, we would have probably blocked the card otherwise". The other one said, "Nah... it's ok, we already see charges for a tux rental, large payment to a hotel, and a travel agency. Our system recognizes those and expects trip-related expenses next".
[/CSB]

And that was 6 years ago, before analytics became a buzzword. Newer systems would probably include GIS data and other variables to account for possible explanations to deviations from the trends. If Big Pharma already analyses that data to tell its sales rep which dr. and/or which pharmacists they need to pay a visit to, there's no reason why the Feddle Gummint wouldn't be able to do the same.

I don't think Grandma risks being denied her arthritis meds by HAL, yet.
 
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