Page 19 - C.Journal 3rd edition

Claims Journal 3rd Edition Claims Journal 3rd Edition

Fraud Detector:

A great observation from our colleague Rayan AlSaeed , he noticed that this member
dispensed the same medications 5 times during the month of august, from 5 different
providers.

Actually he did the same thing each month.
Rayan escalated all his doubts to his Manager , who in turn rise it to fraud team.
Fraud team found that this member is considered as a medication shopper, and in turn they
terminate him.
Thank you
Rayan AlSaeed

Also a special thanks to Marwa Ibrahim, as she noticed another 2 cases of medication shopper, both
of them was re-dispensing same medications more than 3 times in one month.
Thank you Marwa
18 19