EMR’s Role in the Prevention of Medical Fraud

FOR IMMEDIATE RELEASE
(Free-Press-Release.com) June 17, 2009 --
While there is no doubt the right EMR medical practice software can guarantee Health Care Stimulus funds, increase your ROI with higher E&M coding levels, and eliminate paper, often overlooked is the role EMR software can play in the prevention of fraud and malpractice.

Off-Label Marketing Fraud



Eli Lilly agreed to pay $1.4 billion to settle federal civil and criminal claims for off-label marketing of Zyprexa. Source: http://www.devicelink.com

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EMR’s Role in the Prevention of Medical Fraud

The federal government has accused Forest of bribing pediatricians to prescribe Lexapro and a related drug, Celexa (citalopram), to treat depression in children, even though such use has not been approved by the FDA at the time. The government also claims that Forest concealed the results of studies showing the drugs to be no more effective than a placebo. Source: http://www.conspiracyplanet.com



Recently, the federal government has dedicated substantial resources, particularly in South Florida , to the prosecutions of physicians and clinic owners alleged to be engaged in fraud related to the administration of HIV medications; these were preceded by increased audits and overpayment demands with regard to most of the physicians and clinics later prosecuted.



The targets of these audit investigations often extend not only to pharmacies, but physicians who issue a large number of prescriptions for expensive medications. Souce: http://www.healthcarefraudblog.com

Combating off-label marketing fraud with EMR



Selecting an EMR software solution that integrates a drug database of medications classified by NDC and includes drug-drug and drug-allergy interactions in addition to conditional use recommendations with generic equivalents can help. Having this information fully available at point of assessment and prescription writing can be paramount in spotting off-label marketing conditions.



PrognoCIS EMR goes one step further by enabling physicians to pre-define a list of drugs for specific conditions, enabling consistency in what is prescribed and when.

Fake Pharmacy Websites



An estimated 543 of these fake pharmacy web sites are introduced into the Internet every week. These fake pharmacy web sites look and feel like the real deal. They offer elaborate shopping carts, drug information, collecting a users name, address and credit card numbers. However, the drugs are never delivered. Source: http://threatchaos.com

Why do consumers flock to the web, and risk purchasing placebos, identity theft and non-delivery? There are several reasons. Most apparently is the potential cost savings followed by inadequate or no medical insurance to help cover the prescription costs.

Controlling the patients need for offshore pharmacy



Leveraging EMR software that helps physicians prescribe lower cost generics and effective alternatives, coupled with the ability to quickly access available trials and programs patients may quality for. Additionally, educating your patients from your patient portal and printed documentation can help.



Have a list of reputable resources available for patients without adequate medical insurance or those who are financially strapped.

Case in point: Person X is a 40 year old male, working full time with a middle class income, raising 2.5 kids. He has adequate to good insurance allowing unlimited doctor visits with a 25.00 copay per visit. At 40 years old, a typical male may have several problems like high cholesterol, acid reflux, maybe even the dreaded ED… This patient may require 3 prescriptions (Crestor, Prevacid and Cialis). Most physicians will prescribe 30 tabs of each, giving this person a full month’s supply of medications. Additionally, with a good prescription plan, filling medications may cost 25.00 for name brands, and 15 for generic. Doing the math, person X has to pay 100.00 (copay + 3 prescriptions) every month in addition to his overpriced medical plan. Not to mention the time off work required to come into the office each month for checkup and refills. Online, person X can purchase Crestor, Prevacid and Cialis in 3-6-9 month supplies, without ever having to make a copay or take the time off work for an office visit saving hundreds of dollars in the course of a year.

Leveraging your EMR solution to provide low cost alternatives, prescribing non-addicting medication in larger quantities can help.

Rampant Prescription Drug Fraud



California Attorney General Brown announced a crackdown on rampant prescription drug fraud in California, including the top fifty abusers who average more than 100 doctor and pharmacy visits to collect massive quantities of addictive drugs like Valium, Vicodin, and Oxycontin. Source: http://www.jerrybrown.org

Controlling rampant prescription fraud with EMR



What if a patient walked into your medical office, complaining of sever back pain? Your staff enters the patient demographics, populating his or her electronic medical record through the HL7 exchange. There you see 68 prescriptions for narcotics and 43 doctor visits with other physicians this year alone!



I rest my case…

While EMR alone cant stop medical fraud, it can help prevent it on several fronts.



Better software, better patient information, put PrognoCIS EMR on your short list.

More information can be found online at http://www.octavesolutions.com

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