Victorri-Vigneau Caroline, Larour Katia, Simon Dominique, Pivette Jacques, Jolliet Pascale
Service de Pharmacologie Clinique, CEIP, CHU Nantes, Nantes Cedex, France.
Therapie. 2009 Jan-Feb;64(1):27-31. doi: 10.2515/therapie/2009004. Epub 2009 May 26.
Make it possible to spot falsified prescriptions which were delivered and reimbursed.
1- Use health insurance administration data bases to single patients liable to suspicion of fraud (repeated presentations of the same prescription to several pharmacies the same day) 2- Attribution of a diagnosis of fraud, by the CEIP (Center of Evaluation and Information about Pharmacodependence) based on transferred data, and by the medical department analysis of the complete file, and convocation when applicable 3- Calculation of quantitative performance of the tool.
We have singled 2030 patients. Among them 25 were able to get 553 deliveries out of 288 pharmacies from 114 prescriptions in one year. Our tool specificity is 99.5% and its sensitivity 69.4%.
Creating this tool which can become automatic and used on a large scale, brings a new light in the evaluation, by making hindsight fraud detection possible.
能够识别已交付并报销的伪造处方。
1 - 利用医疗保险管理数据库筛选出疑似欺诈的患者（同一天向多家药店重复提交同一张处方）。2 - 由药物依赖评估与信息中心（CEIP）根据传输的数据进行欺诈诊断，并由医疗部门对完整档案进行分析，必要时进行传唤。3 - 计算该工具的量化性能。
我们筛选出了2030名患者。其中，有25人在一年内凭借114张处方从288家药店获得了553次药品交付。我们的工具特异性为99.5%，敏感性为69.4%。
创建这种可实现自动化并大规模使用的工具，通过实现事后欺诈检测，为评估带来了新的思路。
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