Group 292

Worker’s Compensation Pharmacy Claims Audits

Worker’s Compensation Pharmacy Claims Audits

Some estimates suggest up to 3% of drugs in the US supply chain are counterfeit.​

Intelaform provides worker’s compensation medication payment audit services to identify fraud, waste, and the abuse of RX medications undetected by PBMs.

For companies that provide employee benefits, it is difficult to keep up with the consistent changes in compliance and drug cost increases. Relying on your PBM to work on your behalf can lead to lost savings and significantly increased risk of counterfeit drugs. Intelaform provides your company with the guidance and expertise needed, along with a database unsurpassed by any other auditing company. We provide opportunity for improvement within plan operations, efficiency, controls, and management of the benefits program. ​​

Why do counterfeit drugs go undetected by PBMs? Because PBM’s don’t have the following: 

  • Global Master Manufacturer Rx Product Databases 
  • Product Identifier Screening Tools 
  • Systems for Auditing Drugs for Counterfeit, Diversion, and Fraudulent Documentation 
  • Auditing Capabilities for potentially illegal and Secondary “Boutique” Supply Chain Products 

The Intelaform Solution:

Intelaform is your experienced, independent partner in Rx cost control and compliance. We assist stakeholders and employers prevent fraud, abuse, and undetected counterfeit drugs. ​

We have the Global product surveillance experience and Supply Chain audit infrastructure required to identify potentially suspect drug products. In addition to our experience and infrastructure, we also have audit system procedures that have been used to monitor Global and U.S. supply chain integrity for 12 of the top 20 pharmaceutical companies.  

Intelaform also has proprietary prescription drug auditing systems that correlate pharmaceutical product supply chain data with claims processing data. All of these things combined result in sound, extensive auditing and increased internal controls. 

The Intelaform Process:

Component 11 – 1

Intelaform compares claim data with its database in order to determine suspect products. When analyzing for potential counterfeits, we:​

  • Compare products to the Intelaform authorized product list 
  • Compare products to the Intelaform supplier list 
  • Analyze DSCSA information 

Intelaform creates an aberrant claims list and requests DSCSA information for those products to develop pattern recognition framework, uncover repeating suspect products, and identify repeating suspect suppliers.

Component 9 – 1