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Do Your Part: Report Fraud

May 16, 2013

Express Scripts has one of the most robust fraud, waste and abuse (FWA) programs in the healthcare industry. In fact, says Jo-Ellen Abou Nader, senior director, Network Audit & Program Integrity, we are the only pharmacy benefit manager that also consults with its clients about potential FWA on the health benefit side.

But her team couldn't do it without the help of an important group — Express Scripts employees. A lot of investigations begin from tips received on the Fraud Tip Hotline. And while data analytics plays an important role in identifying fraud, the team still depends on employees to be on the lookout, says Michael Testa, senior manager of investigations.

"If your instinct says something isn't right, something probably isn't right," Michael says. "Everybody within the company has an opportunity to potentially spot something that may be worth reporting."

He has spent his entire professional career working on fraud, waste and abuse, and if there is one thing he has learned, it is that if something doesn't seem right with a prescription, it is worth a second look.

"Trust your instincts. Report it," Michael says.

Express Scripts Fraud Tip Hotline: 866.759.6139  Email: TRICAREfraudtip@express-scripts.com


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