Melissa Jampol Quoted in “Highmark Saved $15M Working with Feds to Fight Opioid Fraud”

AIS Health: Health Plan Weekly

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.