As a healthcare professional in Texas, you may have undergone training regarding fraud, waste and abuse in the workplace. It is critical that you understand what this entails, as you do not want to be associated with a situation involving fraud.
Prescription drug fraud, wage and abuse comes with many harsh penalties, including hefty fines, job loss and potential jail time. Those who are convicted of prescription drug fraud may lose their professional license and have trouble gaining employment in any related health field after completing their penalties.
What is fraud, waste and abuse?
Prescription drug fraud occurs when a person intentionally uses false information, such as a fake name or diagnosis, to get an insurance company to pay for medication, according to the American Pharmacists Association. A pharmacist who uses the wrong insurance or forge prescriptions is an example of fraud. Waste, on the other hand, is involved when a professional or company overutilizes services, resulting in unnecessary costs. For example, a pharmacy sends prescriptions that were never ordered by the doctor or the patient, simply to bill the insurance and obtain payment. Actions that result in extraneous or inflated payments for prescription drugs are known as abuse. This occurs when a pharmacy bills the insurance for a brand name drug and dispenses the generic drug to the patient.
What is the outcome?
Fraud, waste and abuse affects everyone. When healthcare professionals fill fraudulent prescriptions, waste services and abuse payment systems, it drives up the price of healthcare and insurance coverage for all patients. In fact, healthcare fraud leads to the loss of billions of dollars throughout the U.S. annually.