Express Scripts Unveils Comprehensive Fraud, Waste And Abuse Program For Workers' Compensation Clients

ST. LOUIS, Feb. 27, 2012 /PRNewswire/ -- Express Scripts, Inc. (NASDAQ:ESRX) announced today it has established a comprehensive Fraud, Waste and Abuse (FWA) detection program for workers' compensation payers, which can help stem the rising costs associated with the widespread abuse of prescription narcotics.

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The new Express Scripts program offers a suite of services that can identify fake or forged prescriptions, overprescribing, prescriber-patient collusion, and injured worker identity theft or drug-seeking behavior.

"Injured workers who abuse prescription drugs put themselves and others at risk," said Tim Pokorney, clinical director of workers' compensation at Express Scripts. "Physicians who facilitate this type of behavior are also adding costs to the system and risk to workers' compensation payers. Given how common the use of narcotics is in treating workers' compensation patients, the cost of such abuse can add up fast.

"Existing programs are structured to catch anomalies such as patients with too many prescribing physicians or higher than normal dosage of narcotics. But industry-wide, such programs are not geared toward identifying fraudulent activities. Express Scripts' new FWA program is designed to do just that."

Express Scripts already offers advanced clinical programs, such as Retro Drug Utilization Review and ScriptAlert, to identify potentially fraudulent or wasteful drug prescribing and usage patterns in workers' compensation claims. Combining these capabilities with the company's expertise in analytics, along with a dedicated team of experts, the FWA program provides payers a new tool to detect and address potential problems. Express Scripts' team of experts includes registered nurses and pharmacists, attorneys, accredited healthcare fraud investigators, certified public accountants, former law enforcement officers, fraud examiners and internal auditors.

Prescription-drug abuse costs carry a high price tag. Research shows that pharmacy costs for opioid abusers are five to seven times greater than those for non-abusers. The average medical cost for abusers is $12,406 higher than non-abusers. Since opioids make up a large percentage of the drugs prescribed for injuries leading to workers' compensation benefits, fraud and abuse adds up to tens of millions of dollars of added waste.

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