FWA is a problem based on the IDENTIFICATION of high probability offenders (fraud) and a program to PREVENT high probability abuse and waste. Since FWA can occur when prescribers, patients, or pharmacists err for any one of multiple reasons -- e.g., intentional fraud, careless waste, or abusive behaviors – management must attack the problem using multiple strategies.
These strategies target prevention while the most egregious offenders are targeted for fraud.
- What are the high probability intervention opportunities?
- What interventions are possible at point-of-sale?
- What are the opportunities for preventing further abuse or waste?
- Make FWA a resource-efficient and cost-efficient process
- Target prevention to limit the time and resources spent on prosecuting fraud
- Target high value fraudulent opportunities
Important client benefits are –