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Fraud and Abuse Detection Helps Protect Manufacturers' Reputation and Resources While Focusing on Patient Safety

HealthBridge Pharma & Biotech's Fraud and Abuse Detection services help manufacturers monitor for potential patient and physician fraud and abuse within the Patient Assistance Programs.  An advanced detection program gives you peace of mind while allowing you to focus on core competencies - the development and distribution of life-enhancing treatments.

Why Choose Our Program

The benefits of our program:

  • Identify potential fraud and abuse cases related to
    Patient Assistance Programs
  • Keep drugs in the marketplace, and off the street
  • Identify fraud and diversion schemes that affect the bottom line
  • Limit risk associated with drug seekers
  • Access industry insight - our experts can provide consultation on fraud and abuse issues

Diverse Expertise

Our unique team is made up of a diverse group of highly trained subject matter experts in the following areas:

  • Pharmacy
  • Clinical
  • Law Enforcement
  • Analytics
  • Audit
  • Accounting
  • Legal (JD)

Best-in-Class Program Design

The Fraud and Abuse Detection team uses an array of methods to detect patient and physician fraud and abuse for our clients with Patient Assistance Programs.  Each program is customized by the drug and fraud concerns.  Many include the following elements:

  • Advanced Analytics & Data Mining - The Fraud and Abuse Detection team uses proprietary data processing and fraud detection techniques to identify fraudulent or abusive patterns by:
    • Patients
    • Prescribers
    • Patient advocates
  • Fraud Tip Hotline - A dedicated fraud tip hotline allows anyone (i.e. patients, relatives of patients, physicians, patient advocates) to report suspected fraudulent activity.
    • Hotline number can be published on packing slips, physician fax communications, Patient Assistance Programs applications, or any other document specific to client.
    • Hotline is monitored by HealthBridge Pharma & Biotech's Fraud and Abuse Detection team
    • All tips are reviewed and/or investigated
    • Callers can remain anonymous
  • Investigative Services - Special Investigators conduct comprehensive investigations into all instances of potential fraud and abuse.
  • Reporting - On a quarterly basis, the HealthBridge Fraud and Abuse Detection team will collaborate to provide an extensive report outlining potential fraud and abuse activity, including options for appropriate next actions.

Rely on a Trusted Advisor

HealthBridge Pharma & Biotech's commitment to identifying and preventing the illegal use of prescription drugs has gained national recognition.  As part of the Express Scripts family, we currently provide services for more than 1,800 payers that cover 100 million lives and are pleased to offer our customers access to our top executives for market insight and strategic guidance.

To learn more about how HealthBridge Pharma & Biotech can provide Fraud and Abuse Detection services for your products, contact Kevin Cast, VP Strategy and Contracting, Pharma & Biotech:  kgcast@express-scripts.com or 407-491-6094.

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