Melissa L. Jampol, Member of the Firm in the Health Care and Life Sciences and Litigation practices, in the firm’s New York office, was quoted in AIS Health: Health Plan Weekly, in “Highmark Saved $15M Working with Feds to Fight Opioid Fraud,” by Jane Anderson.

Following is an excerpt:

Highmark Inc. is working with federal prosecutors to identify and fight fraud related to opioid abuse and says it saved at least $15 million in 2017 as a result. …

Epstein Becker Green attorney Melissa Jampol, a former assistant U.S. attorney who focused in part on health care fraud, cites several high-profile fraud cases involving opioids. …

Opioid treatment is a target for health care fraud because of the money spent by insured patients, especially on inpatient treatment facilities, Jampol tells AIS Health:“ Whenever there’s potential money being made in the health care industry, you see fraud.” …

Jampol says she had a different experience in her days as a prosecutor: Insurers did bring her tips. She agrees that data mining is a key way for insurers to detect opioid treatment fraud and other types of health care fraud but says that in addition to data mining, individual complaints from patients can be a rich source of leads for fraud investigations, especially if they start to show a pattern. Combining data mining with patient complaints is even more effective, she says.

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