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SERVICES Retrospective PBM Audits PBM Contract Review and Consulting Fraud, Waste & Abuse Identification Prospective PBM Audits Desk & On-Site Pharmacy Audits Litigation Recovery Expert Witness Testimony

Our in-house team has developed proprietary computer software that evaluates a series of claims from a past period to determine if the PBM vendor is paying claims accurately in accordance with the terms and conditions of their contracts. We work closely with our clients and their PBM to obtain all the necessary documents to perform accurate and complete retrospective audits. Once clean data arrives, our audit takes approximately 8 - 10 weeks to complete.

MHA's retrospective audit program is divided into two distinct areas:

Contract Compliance Audit - reviews all auditable contract terms and benefit designs to determine if Clients either overpaid or did not receive the service as stated in their contracts.

Business Practice Audit - covers areas of both recoveries and future savings. Many PBM's make the majority of their profits using business practices that are hidden from their Clients.

Our audit services will focus on 100% of retail, mail order and specialty pharmacy claims selected for a particular period and will:

• Verify the validity of submitted claims
• Verify claims pricing based on your PBM agreement
• Verify pharmacy reimbursement based on the provider agreement
• Determine PBM compliance under your rebate agreement
• Report with comprehensive analysis to support all findings
• Provide recommendations for improvements and cost-savings