System and method for detecting drug fraud and abuse
First Claim
1. A computer-implemented method for detecting an improper drug use, comprising:
- determining, by at least one processing device, morphine equivalency data for each drug of a plurality of drugs of a drug regimen of a patient, and for each time period of a plurality of time periods;
determining, by the at least one processing device, a total morphine equivalency for the drug regimen for each time period of the plurality of time periods, wherein the total morphine equivalency for the drug regimen for each time period comprises a sum of the morphine equivalency data for each drug of the plurality of drugs of the drug regimen of the patient for each respective time period;
identifying, by the at least one processing device, a possible instance of the improper drug use associated with the drug regimen based on the morphine equivalency data, using the at least one processor, wherein the identifying comprises determining that the total morphine equivalency for the drug regimen for at least one of the time periods of the plurality of time periods is outside of an expected range compared to a total morphine equivalency for a comparable time period of a peer group associated with the drug regimen;
generating, by the at least one processing device, an alert for the possible instance of the improper drug use; and
causing, by the at least one processing device, an outputting of an indication of the alert.
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Accused Products
Abstract
A system and method for detecting improper drug use utilizes the morphine equivalency of a drug regimen of a patient having an injury to compare the morphine equivalency of the drug regimen of the patient to that of a peer group having the same diagnosis. The comparison may be conducted based on the aggregate morphine equivalency for respective periods of time following the injury or the initial treatment and based on the rate of change in the morphine equivalency for that or another period of time. Based on the results of the comparison, potential instances of drug fraud and/or drug abuse are identified and an alert is generated, and appropriate action is taken, where needed.
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Citations
31 Claims
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1. A computer-implemented method for detecting an improper drug use, comprising:
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determining, by at least one processing device, morphine equivalency data for each drug of a plurality of drugs of a drug regimen of a patient, and for each time period of a plurality of time periods; determining, by the at least one processing device, a total morphine equivalency for the drug regimen for each time period of the plurality of time periods, wherein the total morphine equivalency for the drug regimen for each time period comprises a sum of the morphine equivalency data for each drug of the plurality of drugs of the drug regimen of the patient for each respective time period; identifying, by the at least one processing device, a possible instance of the improper drug use associated with the drug regimen based on the morphine equivalency data, using the at least one processor, wherein the identifying comprises determining that the total morphine equivalency for the drug regimen for at least one of the time periods of the plurality of time periods is outside of an expected range compared to a total morphine equivalency for a comparable time period of a peer group associated with the drug regimen; generating, by the at least one processing device, an alert for the possible instance of the improper drug use; and causing, by the at least one processing device, an outputting of an indication of the alert. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A system, comprising:
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a processing device; and a memory device in communication with the processing device, the memory device storing instructions that when executed by the processing device result in; determining morphine equivalency data for each drug of a plurality of drugs of a drug regimen of a patient, and for each time period of a plurality of time periods; determining a total morphine equivalency for the drug regimen for each time period of the plurality of time periods, wherein the total morphine equivalency for the drug regimen for each time period comprises a sum of the morphine equivalency data for each drug of the plurality of drugs of the drug regimen of the patient for each respective time period; identifying a possible instance of the improper drug use associated with the drug regimen based on the morphine equivalency data, wherein the identifying comprises determining that the total morphine equivalency for the drug regimen for at least one of the time periods of the plurality of time periods is outside of an expected range compared to a total morphine equivalency for a comparable time period of a peer group associated with the drug regimen; generating an alert for the possible instance of the improper drug use; and causing an outputting of an indication of the alert. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21, 22)
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23. A non-transitory computer-readable medium storing instructions that when executed by a processing device result in:
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determining morphine equivalency data for each drug of a plurality of drugs of a drug regimen of a patient, and for each time period of a plurality of time periods; determining a total morphine equivalency for the drug regimen for each time period of the plurality of time periods, wherein the total morphine equivalency for the drug regimen for each time period comprises a sum of the morphine equivalency data for each drug of the plurality of drugs of the drug regimen of the patient for each respective time period; identifying a possible instance of the improper drug use associated with the drug regimen based on the morphine equivalency data, wherein the identifying comprises determining that the total morphine equivalency for the drug regimen for at least one of the time periods of the plurality of time periods is outside of an expected range compared to a total morphine equivalency for a comparable time period of a peer group associated with the drug regimen; generating an alert for the possible instance of the improper drug use; and causing an outputting of an indication of the alert. - View Dependent Claims (24, 25, 26, 27, 28, 29, 30, 31)
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Specification