Test 3 Issues Regarding Misuse and Abuse Flashcards
1
Q
Healthcare Fraud
A
Provider or member (or any individual) intentionally submits a false claim
2
Q
Misuse and Abuse
A
- To use incorrectly: misapply
- Abuse, mistreat
- A corrupt practice or custom
- Improper or excessive use or treatment
3
Q
What’s the difference between fraud and misuse or abuse?
A
intent
4
Q
Substance use disorder
A
recurrent use of substances causes clinically and functionally significant impairment
5
Q
Know the types of most frequently abused prescription drugs
A
- Opioids
- Sedatives
- Stimulants
6
Q
Risk Factors for Prescription Opioid Drug Abuse
A
- Family or personal history of substance abuse
- Middle age
- High daily dosages
- Rx overlap between opioid classes or other drugs of abuse
- Multiple prescribers or pharmacies
- History of mental illness
7
Q
Using DUR for Detection
A
- Collect claim data over selected time period
- Apply criteria based on demographics and predictor variables
- Review members flagged by criteria
- Action determined by PBM policy
8
Q
healthcare providers’ role in stopping misuse and abuse
A
- Communicate with other healthcare providers
- Be aware of patient risk factors
- Watch for early warning signs
- Refer patients for help when needed
- Learn about substance abuse treatment
9
Q
ASHP Statement on Pharmacist’s Role
A
- Prevention
- Education
- Assistance
