When Pharmacy Benefit Managers come calling with million-dollar audit findings, most pharmacies feel cornered. Our clients come to us at that moment – facing devastating recoupments, threatened terminations, or government investigations that could put their business at risk. 

We turn those audits around. 

Recently, our client, a regional pharmacy operator, received an audit determination of $1.9 million for alleged co-payment violations. Our team dissected the auditor's methodology line by line, applying AI-enabled analysis to their purchase history and uncovering systematic errors in how the PBM had applied its models.  

The result: an 88% reduction to just over $200,000, with ongoing work to eliminate the remaining amount. 

This is what we do.  

Through years of defending on-site and desktop audits by CVS Caremark, OptumRx, Express Scripts, Humana, Horizon, Envision Rx, Prime Therapeutics, Magellan Rx, and their third-party contractors, as well as Medicaid and Medicare investigations by CMS and state programs, we've learned where auditors overreach and how to prove it.  

We challenge faulty assumptions, marshal documentation, and push back with the technical and regulatory precision these fights demand. When findings can't be avoided entirely, we minimize recoupments, prevent terminations, and stop referrals to law enforcement before they happen. 

The difference is engagement before the damage is done. Whether you're staring at an audit notice today or want to be prepared before one arrives, early preparation, such as compliance reviews, risk assessments, bulletproof policies, and strategic record-keeping, is what keeps pharmacies in business when others fold. 

Pharmacy Benefit Managers and government agencies are auditing more aggressively than ever. The question isn't whether you'll face an audit – it's whether you'll be ready when it comes.