System and method for detecting drug fraud and abuse

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.

What is claimed is: 
     
         1 . A system for providing an alert indicative of an improper drug use comprising:
 a networked server having at least one processor; and   at least one database associated with the networked server, wherein the at least one processor is configured to:
 determine standardized drug equivalency data of a drug regimen of a patient; 
 determine at least one of a doctor peer group and a pharmacy peer group associated with the drug regimen; 
 determine standardized drug equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen; 
 compare the standardized drug equivalency data of the drug regimen of the patient to the standardized drug equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen; 
 identify a possible instance of an improper drug use based on the comparison of the standardized drug equivalency data of the patient to the standardized drug equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen; and 
 generate an alert for each possible instance identified. 
   
     
     
         2 . The system of  claim 1 , wherein standardized drug equivalency data of the drug regimen comprises morphine equivalency data. 
     
     
         3 . The system of  claim 1 , wherein standardized drug equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen comprises morphine equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen. 
     
     
         4 . The system of  claim 1 , wherein the improper drug use comprises at least one of drug fraud and drug abuse. 
     
     
         5 . The system of  claim 1 , wherein the drug regimen comprises a prescription drug regimen. 
     
     
         6 . The system of  claim 1 , wherein the at least one processor is selected from the group consisting of a desktop computer, a portable computer, a smart phone, and a personal digital assistant. 
     
     
         7 . A computer-implemented method for detecting improper drug use comprising:
 determining, by at least one processing device, standardized drug equivalency data of a drug regimen of a patient;   determining, by the at least one processing device, at least one of a doctor peer group and a pharmacy peer group associated with the drug regimen;   determining, by the at least one processing device, standardized drug equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen;   comparing, by the at least one processing device, the standardized drug equivalency data of the drug regimen of the patient to the standardized drug equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen;   identifying, by the at least one processing device, a possible instance of an improper drug use based on the comparison of the standardized drug equivalency data of the patient to the standardized drug equivalency associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen; and   generating, by the at least one processing device, an alert for each possible instance identified.   
     
     
         8 . The method of  claim 7 , wherein standardized drug equivalency data of the drug regimen comprises morphine equivalency data. 
     
     
         9 . The method of  claim 7 , wherein standardized drug equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen comprises morphine equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen. 
     
     
         10 . The method of  claim 7 , wherein the improper drug use comprises at least one of drug fraud and drug abuse. 
     
     
         11 . The method of  claim 7 , wherein the drug regimen is a prescription drug regimen. 
     
     
         12 . The method of  claim 7 , wherein the at least one processing device is selected from the group consisting of a desktop computer, a portable computer, a smart phone, and a personal digital assistant. 
     
     
         13 . A non-transitory computer-readable medium storing instructions that when executed by a processing device result in:
 determining standardized drug equivalency data of a drug regimen of a patient;   determining at least one of a doctor peer group and a pharmacy peer group associated with the drug regimen;   determining standardized drug equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen;   comparing the standardized drug equivalency data of the drug regimen of the patient to the standardized drug equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen;   identifying a possible instance of an improper drug use based on the comparison of the standardized drug equivalency data of the patient to the standardized drug equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen; and   generating an alert for each possible instance identified.   
     
     
         14 . The non-transitory computer-readable medium of  claim 13 , wherein standardized drug equivalency data of the drug regimen comprises morphine equivalency data. 
     
     
         15 . The non-transitory computer-readable medium of  claim 13 , wherein standardized drug equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen comprises morphine equivalency data associated with the at least one of the doctor peer group and the pharmacy peer group associated with the drug regimen. 
     
     
         16 . The non-transitory computer-readable medium of  claim 13 , wherein the improper drug use comprises at least one of drug fraud and drug abuse. 
     
     
         17 . The non-transitory computer-readable medium of  claim 13 , wherein the drug regimen is a prescription drug regimen. 
     
     
         18 . The non-transitory computer-readable medium of  claim 13 , wherein the processing device is selected from the group consisting of a desktop computer, a portable computer, a smart phone, and a personal digital assistant. 
     
     
         19 . The non-transitory computer-readable medium of  claim 13 , wherein the instructions comprise a computer application adapted to be executed on at least one of a desktop computer, a portable computer, a smart phone, and a personal digital assistant.