Challenge

• During our quarterly review of claims data in RxMart, Excelsior Solutions noticed some unusually high prices on a handful of prescriptions
• One member was filling all prescriptions at the same pharmacy at a location outside of member’s living area

Solution 

• Excelsior Solutions brought this concern to the PBM’s attention
• Pharmacy was processing fraudulent claims
• Pharmacy closed before PBM could remove it from the network for fraudulent practices

Client Win

• $26,000 reimbursed to client for fraudulent claims that would have gone unnoticed without RxMart’s ongoing monitoring