Pharmacy Audit Services
Gain proactive oversight to identify discrepancies, improve payment accuracy, strengthen compliance and reduce financial leakage
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Delivering for our clients at scale
Effective pharmacy oversight goes beyond compliance
Health plans face growing pressure to detect pharmacy-related fraud, waste and abuse, respond to increased regulatory scrutiny and manage pharmacy spend. Meeting those demands requires more than confirming regulatory compliance — it means uncovering discrepancies and overpayments across pharmacy claims and networks.
Our independent audit approach combines experienced industry professionals, advanced analytics and on-site validation to strengthen payment accuracy, identify sources of financial leakage and provide greater confidence in the accuracy of pharmacy payments.
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Detect fraud sooner
Identify fraud, waste and abuse before they lead to costly losses and compliance risks
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Reduce financial leakage
Uncover claims discrepancies and overpayments that create hidden losses
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Protect payment integrity
Validate what was billed against what was dispensed to support payment accuracy
A full range of tailored audit capabilities
From onsite pharmacy observations and concurrent claim reviews to advanced analytics and reporting, we provide health plans with the expertise, flexibility and visibility needed to evaluate risk, identify discrepancies, uncover financial leakage and strengthen pharmacy oversight.
Customize our services around your needs and priorities:
Fraud, waste and abuse (FWA) detection
Rigorous analysis of pharmacy claims and audit data to identify potential FWA and prioritize high-value findings.
Claims data accuracy validation
Comparative review of claims information against data on actual medications dispensed and payments made to identify and flag discrepancies and accuracy issues.
On-site pharmacy observation
In-person reviews by pharmacy specialists to evaluate on-site practices and validate audit findings.
Regulatory and contract compliance verification
Analysis of pharmacy claims and processes to assess alignment with applicable regulatory and contractual requirements.
Analytics-driven insights and reporting
Enhanced review of audit data using advanced analytics tools to identify trends, prioritize findings and provide visibility into audit activity and outcomes.