BioMatrix Specialty Pharmacy Partners with Modio Health on Combating Prescription Fraud and Abuse

Pre-dispense verification program ensures that every patient prescription is checked in real time for accurate and current prescriber credentials before being filled.

[San Francisco, Calif. — December 13, 2018] — Modio Health has partnered with BioMatrix Specialty Pharmacy for an innovative technology program to improve prescription compliance and reduce fraud. Together, the companies are implementing “pre-dispense verification” — real-time credential checks for each prescription across the national network of specialty pharmacies. Modio’s Carbon™ technology is able to verify a provider’s licenses in seconds or an entire roster in minutes, compared to the sector’s standard lengthy manual process. All provider identities and licenses will be confirmed by BioMatrix as prescriptions and refill requests are received — a process designed to quickly ensure compliance without slowing down delivery to patients.  

“Specialty pharmacies deliver the most time-sensitive, critical, and expensive medications to the healthcare system every day,” said BioMatrix chief clinical officer Marc Stranz. “It is crucial that we do everything we can to verify compliance as we ship medications across the country, both for individual patients and for our healthcare system as a whole. With this Modio Health partnership, we are creating a new standard for accuracy.”

In order to protect patients, specialty pharmacies manage compliance extremely closely across various state regulations and nationally with Medicare and Medicaid. Prescription issues can arise accidentally, for example when a physician’s medical license has expired, they have moved to a new state, or have passed away. The credential compliance process is notably difficult to maintain, with medical practices required to submit an average of 17 credentialing applications per physician each year, according to MGMA data. Issues can also stem from intentional fraud and abuse, which contribute to the estimated $224 billion lost to healthcare fraud in the U.S. each year.

“Modio’s work to modernize our national physician credentialing process has wide implications for healthcare safety and efficiency,” said John Bou, co-founder and COO of Modio Health. “Our partnership with BioMatrix, which has long created innovative technology to safely and quickly serve patients with blood disorders, transplant, and weakened immune systems, shows just one example of how technology to verify physician identity in real time can deliver improved outcomes, less waste, and a better patient experience.”

Download the entire press release here.

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