Case Study: SCAN Health Plan stops predatory pharmacy fraud and achieves $2.5M+ cost avoidance with Alteryx

Life-Altering Analysis to Catch a Predatory Pharmacy

SCAN Health Plan is a nonprofit Medicare Advantage organization serving about 200,000 mostly Southern California members. Its Special Investigations Unit confronted a growing fraud scheme in which members were mailed low‑cost over‑the‑counter lidocaine products while insurers were billed for expensive prescription creams, prompting concerns about multiple pharmacies serving the same patients, shared addresses, and out‑of‑area dispensing.

The team adopted Alteryx to blend and prep data, run network analyses and produce clear visualizations that revealed unexpected pharmacy–member relationships. The work identified and flagged predatory pharmacies, shifted the program from reactive SQL reporting to proactive monitoring and spatial analysis, and delivered estimated cost avoidance of roughly $1.5M in 2017 and $1M in 2018 while enabling ongoing weekly surveillance and better prioritization of investigations.

SCAN Health Plan

Katherine Yue

Senior Special Investigator & Cassandra Olson, Analyst