Case Study: Managed Health Plan Cuts FWA Budget Methods? Problem: A large managed care plan in the Midwest (but serves members in all 50 states) had contracted PIC to perform routine desk audits but did not think “it was worth it” to run claims through COPs. As a value-added service, PIC ran two weeks of claims data through the COPs system. The claim volume was 62,337 claims, involving 5,300 pharmacies and 15,321 providers. Solution: The COPs system identified 37 suspicious clusters of one-on-one or a majority of claims that were one-on-one relationships of pharmacies and physicians of a finite group of patients. However, by bringing in social media and state medical licensing information, the 37 suspicious clusters were reduced to just under a dozen that warranted on-si

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