Lawyer Andrew Sparks Quoted in the Health Plan Weekly Article, “Highmark Saved $15M Working With Feds to Fight Opioid Fraud”
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Lexington Lawyer Andrew Sparks was quoted in the Health Plan Weekly article titled, “Highmark Saved $15M Working With Feds to Fight Opioid Fraud.”
Andrew says, “Insurers need to know the signs of opioid fraud, do their own investigations and make referrals to law enforcement, if necessary. Key indicators of a provider engaged in fraud include up-coded office visits, an unusually high number of patients seen in one day (especially for higher-level office visits) and too many lab tests, such as nerve conduction screenings, MRIs and CT scans. If you look at [a provider] and see that every patient’s revenue potential is being maximized, that’s a potential sign of fraud,” says Mr. Sparks.
To read the full article, please click here.
Andrew says, “Insurers need to know the signs of opioid fraud, do their own investigations and make referrals to law enforcement, if necessary. Key indicators of a provider engaged in fraud include up-coded office visits, an unusually high number of patients seen in one day (especially for higher-level office visits) and too many lab tests, such as nerve conduction screenings, MRIs and CT scans. If you look at [a provider] and see that every patient’s revenue potential is being maximized, that’s a potential sign of fraud,” says Mr. Sparks.
To read the full article, please click here.
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