Predictors of loss due to pharmaceutical fraud: evidence from the U.S.

Yuriy Timofeyev,Mihajlo B Jakovljevic,Susan A Hayes

doi:10.1186/s12962-022-00337-4

Abstract

BackgroundGlobally and in the U.S. in particular, pharmaceutical fraud account for a large number out of all crimes in health care, which result into severe costs to the society. The Academy of Managed Care Pharmacists (Fraud, waste, and abuse in prescription drug benefits. 2019. Posted May 20. https://www.amcp.org/policy-advocacy/policy-advocacy-focus-areas/where-we-stand-position-statements/fraud-waste-and-abuse-prescription-drug-benefits.) estimate that pharmacy fraud is 1% of costs, therefore estimating that pharmacy fraud costs at $3.5 billion, given that pharmacy costs are $358 billion (Statista. Prescription drug expenditure in the United States from 1960 to 2020. 2021. https://www.statista.com/statistics/184914/prescription-drug-expenditures-in-the-us-since-1960/).AimThis exploratory study aims to demonstrate a fraudster’s profile as well as to estimate average consequences in terms of costs and identify the loss predictors’ hierarchy in the pharmaceutical industry in the U.S.Materials and methodsData from the Corporate Prosecution Registry and mixed-effects models are utilized for this purpose. The dataset covers years 2001–2020 and 75 cases, falling into one of the following broad sub-categories: misbranding, counterfeit, off-label use of drugs/deceptive marketing; violation of the Food, Drug and Cosmetic Act.ResultsThe main factors positively associated with loss due to pharmaceutical fraud are: (i) duration of , and (ii) the scheme and scheme being executed at a U.S. public company. Surprisingly, presence of collusion negatively and significantly effects the cost. Potential factors include: (a) principal perpetrator being a white American and/or male, and (b) number of employees at individual and organizational level respectively.ConclusionThis study empirically justifies considering loss, due to pharmaceutical fraud, from a multi-level perspective. Identified profiles of a typical fraudster helped to elaborate on specific practical recommendations aimed at pharmaceutical fraud prevention in the U.S.

Highlights

Health care fraud in the United States costs between $100 billion and $300 billion [1]
The main factors positively associated with loss due to pharmaceutical fraud are: (i) duration of, and (ii) the scheme and scheme being executed at a U.S public company
Identified profiles of a typical fraudster helped to elaborate on specific practical recommendations aimed at pharmaceutical fraud prevention in the U.S

Summary

Introduction

Health care fraud in the United States costs between $100 billion and $300 billion [1]. The level of spending for fraud will only increase as the population in the United States ages. $1.5 trillion, primarily due to an aging population and increases in the costs of health care services [2]. These assessments are largely aligned with the health spending forecasts for the US [3] and other major Emerging Markets up to 2025 [4] and 2030 [5]. Prescription drug expenditure in the United States from 1960 to 2020. 2021. https://www.statista.com/statistics/184914/prescription-drug-expenditures-in-the-us-since-1960/)

Methods

Results

Conclusion