Using Data to Identify Fraudulent Claims Pharmacy Reimbursement of $26,000 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 RxMart detects claims variances