Your GTN is leaking before your audit even sees it

Fraud, waste, and abuse cost billions of dollars every year. Copay programs aren't exempt. ReclaimRx™ catches it while it's happening, not eventually.

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What hits one program is headed for the next.

Pharmacy fraud, waste, and abuse rarely look like one bad actor. They look like patterns: a claim reversed and rebilled within seconds, a prescriber who doesn't exist, a pharmacy working the seams of your benefit design. By the time an audit surfaces any of this, the money is already gone. 

A pharmacy running a scheme like this rarely stops after one program catches it. It moves to the next, often before anyone connects the dots. ReclaimRx is built so a pattern confirmed on one program protects every program on the platform, including yours, even if you're only running one.

GTN Leakage - Anomalies Detected 1264x665
Earlier visibility into undetected leakage. Insight where it didn't exist before.

Fraud and billing schemes evolve.
Static audits don't. 

ReclaimRx is designed to adapt every time. Every confirmed pattern strengthens the system.
That's the difference between a report and a closed loop.

Reveal

Anomalies surfaced across the claims stream, in real time, not in a sample.

Recoup

Suspect claims held before funds go out, and what's already paid gets flagged for recovery.

Reinforce

Every confirmed pattern becomes a rule, so the system gets harder to fool next time.

  1. REVEAL

    Surface the leakage hiding in claims, rebates, and reimbursement data.

  2. RECOUP

    Recover the dollars already lost, with the documentation to support every claim.

  3. REINFORCE

    Feed what you found back into program design so it does not happen twice.

Caught at adjudication, blocked everywhere.

A pharmacy registered an NPI and starts billing almost immediately, with no real patient relationship or dispensing history behind the claims. On a fragmented stack, that pattern clears for months before anyone looks at a quarterly audit and notices something is wrong. ReclaimRx flagged it at the claims level, in real time, and blocked it across every program on the platform, not just the one that surfaced it first.

  • Detection runs against live claims data, not a quarterly sample

  • One confirmed pattern protects every program on the platform, instantly

  • Rule updates happen automatically, with no change order or vendor ticket

Every confirmed pattern strengthens the system. That's the difference between a report and a closed loop.

What ReclaimRx catches:
Patterns standard audits typically miss.

Reversal-and-rebill sequences at the pharmacy level
Prescriber identities that don't hold up to verification
Network-level patterns no single claim would reveal on its own
Program-level drift no single audit catches

Fraud, waste, and abuse move fast. Your defense should too.

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