Prescription drug fraud
Prescription drug diversion is one of the defining drug crimes in America today. It has few equals for sheer size, speed of growth, resistance to deterrence, harm to people from so many strata of society, and large costs to insurers. Overdoses, deaths and injuries continue growing at an alarming rate. In fact, more than 20 million Americans— nearly seven percent of the population— will abuse prescription drugs in 2007, based on the National Survey on Drug Use and Health. Drug diversion's alarming spread over the last five years is well-chronicled.
Research on drug diversion
This report examines largely unreported and elusive aspects of the crime known as drug diversion: the role insurance fraud plays in financing this crime, and the high cost to health insurers and others. These victims include health and workers compensation insurers, employers, pharmacy benefit managers (PBMs) and taxpayer health insurance programs such as Medicare and Medicaid. Combined, insurers pay roughly 80 percent of a national prescription drug bill that is projected to total nearly $230 billion in 2007.
Abuse of addictive prescription drugs has reached epidemic levels in the U.S. The drugs are readily available in large quantities, thus fueling addicts, creating new generations of users, and sometimes killing users who overdose. Read more.
• Drugs kill one person every 14 minutes. Most major causes of preventable death are declining, but drugs are an exception. (ibid)
• Drug deaths outnumber traffic fatalities for the first time in 30 years, fueled by a rise in abuse of addictive prescription drugs. (Los Angeles Times analysis of data from the Centers for Disease Control, September 2011)
• Opioid painkillers cause more overdose deaths in the U.S. than heroin and cocaine combined. (Centers for Disease Control report, October 2011)
• By 2010, enough addictive painkillers were sold to medicate every American adult with a typical 5 mg dose of hydrocodone every four hours for one month. (ibid)
• Diversion costs individual private insurance plans up to $857 million annually; (ibid)
• Expenses of suspected doctor-shopping members of Medco Health Solutions were nearly seven times higher than the monthly cost of members without excessive prescription claims; (ibid) and
• Abuse suspects incurred $41 in claims for office visits and outpatient treatment for every $1 in narcotic prescription claims against WellPoint. (ibid)