Implementation of a prescription fraud detection software using RDBMS tools and ATC coding

During the last years, need for increased funding for national health services offered to citizens is rising. The reasons are (i) decreased ratio of working population/pensioners, as well as (ii) increase of life expectancy. Thus, high priority should be given to safeguarding the reliable administration of the financial resources devoted to this purpose. This paper describes the application of a "clever" system which can be used by social security bodies (SSBs) and healthcare providers for: (a) Electronic data entry of prescriptions written by doctors to patients, (b) Check of prescriptions against predefined rules entered in the system for errors or possible fraud, reporting all ¿suspicious¿ cases. In addition, an integrated system for administering prescriptions was implemented, that offers the ability to query, view and print data in the format required by the user. The application was designed and implemented using Microsoft Access 2002 relational database system environment. For testing the application, data by the Greek Social Security Body of people working in Healthcare (namely T.S.A.Y.) were used; all personal information was removed.