We Only Get Paid After we save you money!
Unscrupulous pharmacies, prescribers and drug companies are literally draining your prescription benefit dollars, paid for bogus drug claims, right in front of you and your Prescription Benefit Manager (PBM). Just a few dozen dubious claims a month could quickly cause leakage of more than $1 Million annually and you may not notice it. Why? Because of the ever increasing costs of prescription drug claims, your other priorities, and assuming that your PBM is protecting you. Need Examples? How about Prenatal Vitamins for MEN?....$20,000/year for one patient!(we found 15 patients). Generic Antifungal Foot Baths?....$35,000/year per patient! Generic Arthiritis Lotions?...$50,000/year per patient! We have exposed and stopped these and many others like it. New scams pop up every month. Once the scammers find out you pay for one covered employee, they devote full time resources to get similar claims paid for others in your plan. Like most employers you probably assumed your PBM, auditors and consultants were working to protect your benefit spend from just such scams. They are not, and you ARE at risk! Until now...
Specially trained investigative Pharmacists will forensically review your detailed PBM claims data regularly to uncover hidden fraud, waste & abuse and other dispensing scams like the ones above that could be costing your self-insured benefits plan $ millions. Once uncovered, we work directly your PBM and you to stop future claims, preventing further loss and, where possible, facilitate refunds to your plan by your PBM. We only get paid when we save you money. Put us to work now to help determine how much you can recapture or stop from leaking through to dubious providers.
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OUR TEAM
Our President & Chief Investigative Officer, Robert J. Schenk Jr, RPh, CCP is lead investigator and trains all pharmacist team members. Bob's meticulous attention to detail has been highlighted in Fortune Magazine and he has recently worked with the FBI and NJ State Attorney General's office to expose a drug payment scam perpetrated on his employer. He has identified, stopped and had refunded over $5 million in less than 2 years.
Nationwide, there are very few pharmacists experienced in analyzing the often times confusing and voluminous claims data provided by PBM's. Uncovering paid claims that maybe the result of Fraud, Waste & Abuse or other scams takes specialized clinical, business, pharmacy operations and investigative training. Typical HR benefit consultants and auditors do not have the clinical pharmacy knowledge to identify the many expanding ways that prescription benefit plans are being ripped off by networks of unscrupulous pharmacies, prescribers, and manufacturers. This is a specialized field of pharmacist expertise that requires almost daily attention to discover new and unusual ways plans are being scammed right under the PBMs noses.
OUR CLIENTS
Our Clients include some of the largest Health Care Systems and IDN's in the country. Maintaining client confidentiality is a key tenet of our business. We have worked with the FBI and State Attorney Generals or Insurance and Banking Departments to notify them when we uncover significant fraud perpetrated against our clients. Confidentiality helps ensure that those inclined to scam payers will not know they are being monitored.
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We also work closely with our client's PBMs and believe it is best to maintain working partnerships with their own internal customer service teams to promote a collaborative relationship. We hope the PBMs will apply our discoveries across their book of business. We believe a fraudulent pharmacy should be removed not only as a provider for our clients but, hopefully, eliminated from participation across an entire PBM network. Since any PBM could be the target of scam artists and fraudsters at any point in time we will not highlight any particular PBM as being more at-risk or more lax in guarding our clients drug benefit spend then any other. That would be like saying one bank is more likely to be robbed then another.
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We are happy to provide references and contacts on request.
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