Summary

Client industry:

Healthcare Insurance

Business challenge:

During a review to remedy overpayments, Special Counsel found incomplete emails and after further investigation, discovered additional documents in a separate repository.

Highlights/outcomes:

Completed the project two weeks ahead of schedule, saving the client approximately $88,000 and with a 97.9% accuracy rate.

Opportunity

Special Counsel’s client, a large health insurance provider, was party to specific retail pharmacy agreements related to their administration of pharmacy claims. Amendments to these agreements led to complaints about unequal pharmacy reimbursement rates for generic drugs dispensed to USVI Medicaid members. Special Counsel’s client was informed of the complaints, and after researching the issue, discovered that due to a system error, a group of pharmacies was overpaid. The client informed the parent company, and initiated the process to recoup the overpayments on behalf of its client. he parent company objected and ultimately filed a demand for arbitration.

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