Date of Award
Master of Science (MS)
Medicaid, Medicare, and major insurance companies are being faced with increased costs for drug test screening. These costs are not caused by a spike in the use of narcotics by subscribers, but from unnecessary testing and overbilling by doctors and drug screening companies. Recovering drug addicts are required to have random drug tests during their treatment program, but instead of being random, the drug tests have become prescriptive. Testing is performed at specific times weekly on a single patient, for substances that return results that are unimportant to the doctors. Doctors are given drug testing kits by large drug testing companies that are very accurate and low in cost. Once the necessary drug tests are completed, the insurance companies are billed for thousands of dollars. The test results are received by the doctors who are able to confirm or deny the use of a particular drug. Next, the doctors send the exact test sample to a drug testing company or laboratory for further confirmatory testing. Medicaid, Medicare, and employers are billed twice by way of the insurance companies, for the same tests on a single patient on the same date of service; first from the doctor and then from the laboratory (The Pathology Blawg). My focus will be to examine the current drug test billing system, assess the risks and vulnerabilities faced by Medicare, Medicaid and the insurance companies and analyze and recommend strategies to detect and eliminate fraud, waste and abuse (FWA) caused from healthcare provider billing schemes.
Walton, Allison, "Counteracting Fraud, Waste and Abuse in Drug Test Billing" (2015). Economic Crime Forensics Capstones. Paper 8.