Pharmacy Benefit Managers are responsible for overseeing drug spending and preventing fraud, but many rely heavily on limited desk audits instead of thorough on-site evaluations. This lack of oversight creates risks of billing fraud, inaccurate claims, and improper prescription handling. On-site audits, though costlier, provide real accountability by verifying inventory, compliance, and dispensing practices in real time. PBMs’ reluctance to expand audits often reflects profit motives such as spread pricing and rebates, which compromise transparency. Conduent addresses these gaps with AI-driven audits, real-time monitoring, and expert oversight, recovering about $1 billion annually for payers.

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