Who Are We?
We are FORENSIC PHARMACISTS who are energized by analyzing PBM claims data most people would rather ignore because of the complexity. We are PASSIONATE about ensuring your PBM is adhering to contract terms and nothing makes us happier then getting your money back to you!
What Are Forensic Pharmacists?
We are SUBJECT MATTER EXPERTS in the areas of drugs, pharmacies, PBMs, pharmacy benefits, and auditing prescription claims. We identify and eliminate hidden plan costs related to fraud, waste, and abuse; Help ENSURE your PBM contract aligns with your fiduciary responsibilities (Does your plan pay for some Brand Names when Generics are available? That could be a red flag); CONFIRM that your PBM rebate payments are not "lost"; IDENTIFY overlooked plan savings opportunities; and, EXPOSE the all-to-frequent calculation errors by the PBM.
Why Pharmacists?
No one knows more about drugs than pharmacists. Pharmacists are intricately involved in the billing and reimbursement for every single claim paid by your PBM. Would your accountant or benefits consultant know that a paid claim for the drug Azesco was actually for prenatal vitamins and being charged for dispensing to male beneficiaries? Would they question $1,758 per month for that vitamin? Probably no to both. We do! Apply that same logic across 2,000+ different medications and you will understand why specially trained Forensic Pharmacists are best positioned to assist in this very specific spend category.
Our Results Speak For Themselves
Pharmacists are known for their attention to detail and for being evidenced-based. We are no different. Unfortunately, even the most diligent plan is vulnerable to the complexities and ever-changing market. Throw in PBMs who are trying anything they can to retain their historical profit margins and you probably understand why having specially trained forensic pharmacists is a great addition to your need for due diligence. Scroll or click over to our News section to see some of our most recent "wins"
We Already Have Too Many Consultants
Clients often ask if our services overlap with their health benefits consultants or their pharmacy benefits plan auditors (if they have them). The answer is usually, no. Our area of expertise is very specific and does not conflict with your annual plan audits (hopefully you have that). We are happy to work collaboratively with any resources you may have to ensure maximum protection is afforded to your plan. In fact, we may need their help getting your money back!
We Only Get Paid After we save you money!
Some unscrupulous pharmacies, prescribers and drug companies are literally draining your prescription benefit dollars, getting paid for bogus drug claims, right in front of you and your Prescription Benefit Manager (PBM). Some PBM's are notorious for simple mathematical calculation "errors", failure to program pricing according to your contract, or simply "losing" rebates you are entitled to. Just a few dozen dubious claims a month or calculation errors or omissions 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 bad actors 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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We believe the shared savings model works best for everyone and allows our clients to have no up front financial risk (The last thing you need to explain is why you are paying another consultant ). However, once we prove to you how valuable our services can be, we are more than happy to consider an ongoing, predictable consulting arrangement based strictly on fee-for-service or hourly rates.
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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 worked with the FBI and NJ State Attorney General's office to expose a drug payment scam perpetrated on his employer. In 2025, he was recruited by the new governor of New Jersey, Mikie Sherrill to participate on her multi-disciplinary task force to help make drugs more affordable for both residents and the State of New Jersey. He has identified, stopped and had refunded to clients and employers $millions in fraud and PBM "errors".
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 for Fraud, Waste and Abuse schemes 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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