Pharmacy Benefit Forensics

Pharmacy Benefit Forensics

 

In a 2013 Fortune Magazine Article, "Painful Prescription", investigative reporter Katherine Eban described Pharmacist Robert Schenk as "Mild-Mannered". Robert was in fact, mild-mannered but singularly focused and doggedly persistent getting to the bottom of, and then exposing, the spread pricing scheme by the PBM that was costing his employer $millions in additional pharmacy benefits costs they had not expected. In fact, he was one of the very few people in the US to have clear evidence of exactly what those spreads were that the PBM was retaining having claims data as both a pharmacy provider and a payer.  

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Since that time, Robert has continued to focus his time and attention on monitoring his employers prescription benefit spend and providing subject matter expertise to ensure the strictest PBM contracts and that the PBM stays within their parameters. Unfortunately, over the ensuing years he has discovered that PBMs can stay in the parameters but still make financial "mistakes" in calculations or errors in plan implementation that can cost even a diligent and knowledgeable employer $ millions in a very short period of time if not caught. The most egregious discovery was the rather lax oversight the PBMs provided to detect and stop what appeared to him to be obvious Fraud, Waste & Abuse when it was happening in plain sight and found by him in the monthly detailed claims data.  After realizing just how easy it was for unscrupulous characters to reap large financial payments quickly at the expense of his employer, Robert began to research the many reasons how that could happen without the PBM (assumed to be the steward of his self-insured employers benefits dollars) noticing and to be so easily duped into payment of what appeared to him to be dubious prescription claims. Researching the area he soon found examples all across the country of employers being scammed out of prescription benefit dollars by multiple providers using the same techniques. It was rampant. 

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He quickly realized that todays' complex pharmacy benefit claims and payment system and the high cost of even simple generic medicines made it very easy for certain providers to collude and scheme and file      $ thousand claims that were easily paid by the PBM and "lost" within a nationwide payment system processing millions of claims worth $ billions monthly. After all, who was going to notice a $3,000 claim here or there for a generic Diclofenac solution being supplied from a pharmacy halfway around the country. Well, fortunately, Robert did. 

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Since discovering the magnitude of the fraud, waste and abuse, Robert has once again set out to right the system he helped expose in 2013 and protect his employers hard earned prescription benefit dollars. Now, he works closely with the new Vice President  of Benefits at his employer who affectionately refers to him as "Columbo", the TV detective from the 70's that always seemed to have "one more question" which he always knows the answer to before he asks it. 

 

Upon his realization that he appeared to be a lone detective in a $ billion dollar industry rife with fraudulent pharmacies, prescribers, and even drug manufacturers he set out to spread the message, stop the fraud and abuse, and recapture funds. The result was his creation of Pharmacy Benefit Forensics, LLC where he is President and Chief Investigative Officer. 

 

Robert continues to be mild-mannered in nature and always has a smiling demeanor except when confronted by the latest prescription billing scam and the bogus claims and schemes he identifies when analyzing detailed prescription claim data. He has worked with the FBI, State Attorney Generals Offices and State Insurance and Banking Departments to help rid the industry of the fraud but decided the job was too big to do alone. Through Pharmacy Benefit Forensics, LLC,  Robert has now set out to train an army of like-minded pharmacist "Columbo's" to help self-insured employers retain and recapture more of their hard earned prescription benefit dollars.

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