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Administrator Gets 68 Months For $6M Fla. Health Care Fraud
DEA Drug Reclassification-Tramadol and Hydrocodone Combinations
Midwest Claim Conference May 2015
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Healthcare Fraud Shield developed a predictive prepayment FWA system, PreShield™ that is fully integrated with our postpayment and case management systems.  PreShield™ is designed to: 
  • Focus resources on the most viable and prospective suspicious claims using real-time data
  • Daily feeds that can be tailored based on claim attributes, staff availability, staff expertise, company initiative, and regulatory alerts and guidance
  • Increase ROI
  • Reduce dollars lost by preventing fraudulent claims to be paid
  • Reduce the level of effort needed by investigators/analysts to find the fraudulent claims by reducing the excessive false positives returned by other fraud systems, allowing the staff to focus on the tangible suspicious claims/cases
  • Clear, concise and detailed alerts that provide reference points and helpful training on complex fraud topics and new schemes
  • Increase the intelligence of the product over time based on prior results, strengthening the use and efficacy of predictive analytics Work seamlessly with your postpayment and case management system
  

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Welcome! This week's Healthcare Fraud Shield article examines the impact of "DEA Drug Reclassification-Tramadol and Hydrocodone Combinations.Check out the article below or on the Healthcare Fraud Shield blog where you can access our previous articles.

Sincerely,

 

Healthcare Fraud Shield  
DEA Drug Reclassification-Tramadol and Hydrocodone Combinations

The Drug Enforcement Agency[1] (DEA) announced the final ruling on July 2, 2014 that Tramadol will be reclassified as a Schedule IV effective August 18, 2014. Tramadol is a centrally acting opioid analgesic first approved for use in the U.S. in 1995 under the name "Ultram."  Since then, the FDA has approved for marketing generic, combination and extended release versions. DEA acknowledged that the changes would take time to implement. They extended the usual effective date from 30 to 45 days to provide ample time for manufacturers, pharmacies and physicians to comply with the handling requirements for Schedule IV drugs.


 

As of August 22, 2014, the DEA [2] published a final rule moving hydrocodone combination products (HCP) from Schedule III to Schedule II, to come in to effect October 6, 2014. Under the 21-page document listed on the Federal Register [3], it outlines the Schedule II requirements that apply to all pharmaceuticals containing hydrocodone currently on the market in the United States.


 

Only prescriptions issued before October 6, 2014, and authorized for refills may be dispensed, as long as such dispensing occurs before April 8, 2015. The DEA will also allow a practitioner to issue multiple Schedule II prescriptions in order to provide up to a 90-day supply of medication in accordance with 21 CFR 1306.12 [4]. Furthermore, DEA regulations do not require patients to be seen monthly by their provider. Rather, practitioners must determine on their own, based on sound medical judgment, and in accordance with established medical standards how often to see their patients when prescribing controlled substances.


 

SIU Investigators and Auditors need to pay close attention to the Written Date on all prescriptions for HCPs. If an HCP prescription is written after October 6, 2014, they must be treated as a Schedule II prescription. Meaning, NO REFILLS, Prescriber DEA/NPI Number must be present and make sure the prescription is, in fact, valid by state and federal requirements. SIU staff should also review claims for Tramadol to ensure all state and federal requirements are being met as a Schedule IV medication.


 

Did you know that Healthcare Fraud Shield has the ability to integrate your pharmacy claims with your medical data to help identify schemes such as this one?


 
If you have any questions, please email us at SIU@hcfraudshield.com.

 

  

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Healthcare Fraud Shield offers an integrated FWA platform combining prepayment, postpayment, an ad-hoc querying tool and case management in an all-in-one solution. To see an overview of Healthcare Fraud Shield Products and Services click HERE to schedule a demo. 
  
About Healthcare Fraud Shield

Healthcare Fraud Shield is based in Chesterfield, Missouri and provides advanced FWA (Fraud, Waste and Abuse) detection systems to the healthcare industry. The company's services enable investigators to quickly identify suspicious activity and accurately pinpoint fraud. Our unique technology allows our customers to maximize loss prevention and recovery efforts with a substantial ROI.

 

16052 Swingley Ridge Road, Suite 200, Chesterfield, Missouri 63017
Phone: 888-333-8140 Email: Info@hcfraudshield.com
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