Experts: Better Tech May Be Driving More Fraud Detection

OptumRx, the PBM subsidiary of UnitedHealth Group, claims that pharmacy waste, fraud and abuse increased in 2020 due to the pandemic — and that independent pharmacies are to blame. While experts won’t rule that out, they also observe that new fraud detection technology might have more to do with the eye-popping findings than any perceived shortcomings of independent pharmacies.

OptumRx tells AIS Health, a subsidiary of MMIT, that pharmacy waste, fraud and abuse increased during 2020.

© 2024 MMIT
Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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