Using Data to Identify Fraudulent Claims

Pharmacy Reimbursement of  $26,000


  • 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


  • 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

RxMart detects claims variances