This presentation by Health 2.0 Conference talks about pharmaceutical fraud and what are some of the most common spam perpetrated by scammers. This presentation also highlights how AI can help mitigate the effects of fraud better than any traditional method.

1. Pharmaceutical Fraud:
Health 2.0 Conference Highlights Scams

2. Table Of Contents
● What Is Pharmaceutical Fraud: An Introduction
● Common Frauds Of The Pharma Industry
● AI Helping Patients To Mitigate Fraud

3. What Is Pharmaceutical Fraud:
An Introduction
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4. As spoken about in eminent health and wellness summit like the Health 2.0 Conference talks
about the spam as false claims are made to Medicaid, Medicare, or private insurance companies
that pay for patient medication therapy as part of a wide variety of activities known as
pharmaceutical fraud. The term pharmaceutical fraud encompasses a wide range of distinct
actions.
★ Charging pharmacy providers for medicines that are not utilized and are returned;
★ Selling, promoting, and marketing medicines for purposes not authorized by the FDA;
★ Illegally promoting medications to doctors by giving them financial or other perks, such as
paid consultation trips for medical professionals who attend drug marketing promotional
seminars;
★ Charging the government with fees greater than those the law permits.

5. Common Frauds Of The Pharma
Industry
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6. Delegates who attended the Health 2.0 Conference discussed the types of pharma
scam, and the following slides contain the most common of them for your reference:-

7. Illegal Drug Switching:
➢ Highlighting the common types of fraud, speakers of the Health 2.0 Conference highlighted that
generally pharmacies are required to fill patient prescriptions precisely as the ordering doctor
prescribes them.
➢ Except for circumstances where a generic medication may replace a name-brand drug, pharmacists
are not permitted to dispense medicine in its liquid form when a pill or tablet is prescribed.
➢ False Claims Act violations include billing government insurers for drugs subjected to such
fraudulent activities, assisted the speakers at the keynote sessions of the Health 2.0 Conference.
Fraud By Pharmacy Benefit Managers:
➢ PBMs are a target of fraud investigations more frequently now. PBMs are third-party managers of
prescription medication programs for Medicare Part D plans and other health insurance systems.
➢ PBMs, conduct fraud by neglecting to pass on client savings via rebate agreements and subsidies,
creating formularies that favor more expensive medications, and incorrectly switching medications
to either a generic version of the prescribed medication or a different brand name medication.
➢ Further the attendees of the Health 2.0 Conference anti-scam pharmacy agenda quipped that when
drug makers provide price reductions on specific medications in exchange for a PBM's favorable
product coverage, they are engaging in fraud.

8. Off-Label Marketing:
➢ The FDA has not officially authorized applications, dosages, or demographics for which
pharmaceutical firms may advertise their products as safe and effective.
➢ The FCA is broken by such "off-label" marketing and advertising.
➢ This can happen, for instance, if the medicine is promoted widely for use in relaxing older adults in
nursing homes even though it has only been licensed for treating severe mental illnesses by the
drug firm.

9. AI Helping Patients To Mitigate Scam
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10. Technological advancement has been a boon to every economic sector, including healthcare. Experts
at the Health 2.0 Conference helped mitigate spam effects using new technologies like AI and big
data; check out!
❏ Manufacturers have traditionally responded to income leakage reactively and relied on crude rule-based
methods or human interventions to uncover fraud.
❏ Manufacturers must use sophisticated analytics to identify potential fraud indicators early on and in real-time
because the cost of missing them is getting too high for them to rely solely on traditional techniques, given the
evolving stakeholder interactions and manifestations of fraud, especially across expensive specialty products.
❏ Fortunately, developments in artificial intelligence (AI), big data, and process automation offer
pharmaceutical companies a rare chance to develop a fraud detection capability that can spot patterns,
uncover hidden interactions or relationships, and identify new rules that might go undetected using
conventional methods.

11. Thank You!
This Presentation Is Prepared By
Sarika Gautam
Manager, Health 2.0 Conference