Table 3. The Indicators and the Statistics of Selecting the Clusters Indicating the Physicians Who Were Suspect of Perpetrating Abuse or Fraud .
Indicator | Mean | SD | Mean | SD |
Abuse detection |
Cluster 1 – 46% (75 physicians) |
Cluster 2 – 54% (89 physicians)a |
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Percentage of the patients that they were visited more than once in a month | 16.20 | 5.46 | 21.72 | 11.20 |
The average of the prescript drug items in a claim | 3.54 | 0.57 | 4.66 | 0.57 |
The average cost of a drug prescription claimb | 23827 | 5398 | 29668 | 5662 |
The ratio of the 5 expensive antibiotic prescription to all physician claims | 0.25 | 0.11 | 0.39 | 0.17 |
The ratio of injection prescription to all physician claim | 0.81 | 0.30 | 1.53 | 0.42 |
The ratio of total injection prescription to all physician claim | 1.55 | 0.74 | 2.92 | 0.83 |
The ratio of total prescript antibiotic to all physician claims | 0.68 | 0.18 | 1.06 | 0.19 |
The ratio of injected antibiotic to physician claim | 0.19 | 0.11 | 0.44 | 0.15 |
The ratio of injected corticosteroid prescription to all physician claim | 0.26 | 0.13 | 0.48 | 0.19 |
Fraud detection |
Cluster 1 – 98% (160 physicians) |
Cluster 2 – 2% (4 physicians)a |
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Percentage of reduplicative patients | 30.05 | 10.58 | 41.87 | 15.23 |
Percentage of reduplicative patients-pharmacy | 22.92 | 10.43 | 37.49 | 18.28 |
Percentage of reduplicative patients-pharmacy in a month | 5.70 | 3.19 | 10.09 | 4.88 |
The average cost of a drug prescription claimb | 26656 | 5902 | 40613 | 4756 |
The ratio of claims referred to a high-cost pharmacy | 0.08 | 0.24 | 4.16 | 1.16 |
a Cluster 2 indicates the suspect group.
b This indicator has been used in the detection of fraud and abuse.