Case Study: The Effects of Not Rewarding Bad Behavior and Rewarding Good Behavior Problem: A well-known compounding pharmacy was continuously submitting expensive compound claims but at the same time, the pharmacy, located in an underserved area of Chicago, was also submitting legitimate claims. The concern was to expose and reduce the “bad” expensive compound claims while maintaining the pharmacy in the client’s network to service members. Most pharmacies that submit inappropriate claims (i.e. phantom claims or costly and unnecessary compound claims) also submit legitimate claims for members in need of their services. In classic criminological theory terms, we are attempting to establish a capable guardian over the pharmacy claims submission process and frustrate the pharma

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