Pharmacy first
Pharmacy first. Pharmacy deepest. Pharmacy only.
Every generalist FWA platform has a pharmacy module. We have a pharmacy product.
Closed-loop reconciliation
The receipt is not the source of truth. The authorization is.
Every claim ties back to an authorization registered before dispensation. Forgery becomes structurally impossible.
Real-time AI detection
Real-time AI fraud detection. Before the claim is paid.
25 rules plus an AI anomaly layer at claim submission. Not batch audits after the check cleared.
LATAM intelligence
Built for Latin America, not translated into it.
Latin American pharmacy, nothing else. Production-proven in Bolivia today.
Proven results
43.4% of pharmacy spend was detectable anomaly. Observed, not modeled.
Observed on a real 50,000-subscriber Latin American book. $5.1 million of detectable loss in one year on that book.
Three-week POC
3-week proof of concept. No integration required.
We ingest a claims sample. You get your own WAFL breakdown on real data. International Innovation Award 2025.
What makes us different
Five arguments. Five pages. One bet.
Pharmacy First
Pharmacy is the whole product. That is why ours is deeper than any generalist's.
Closed Loop
The receipt is not the source of truth. The authorization is.
Real-Time AI
25 rules plus AI at claim submission. Not audits at month-end.
LATAM Intelligence
Built for Latin America. Local regulators, local economics, local schemes. It is all we do.
Proven Results
43.4% of pharmacy spend is detectable anomaly. Measured, not modeled.
The same small patterns repeat thousands of times
Each transaction looks like less than $50 USD. Frequency turns pennies into millions.
$16/dispense — Brand dispensed when generic available
71% of branded products have a generic available and it’s clinically safe 99.8% of the time — but less than 5% is dispensed as generic.
$13/dispense — Same molecule re-authorized within 72 hours
1 in 5 subscribers affected. No clinical scenario requires the same drug twice in 3 days. Each transaction appears valid on its own.
$41/dispense — Early refills on chronic medications
1 in 16 subscribers. 30-tablet prescriptions refilled with less than 33% consumed. Consistent with stockpiling or diversion.
$22/dispense — Medication with no diagnostic justification
1 in 6 subscribers received a drug with zero diagnostic justification. 80% were for the wrong body system entirely.
$14/dispense — Cumulative dose exceeding safe limits
433 subscribers with multiple dispenses of the same molecule in 7 days. If the patient took everything as dispensed, it would be dangerous.
$26/dispense — Cloned prescriptions reused months later
Same exact medication list, same prescriber, resubmitted months later. Invisible to systems that evaluate transactions individually.
Total projected cost: $5.1M/year per 50,000 subscribers.
Annual costs projected per 50,000 covered subscribers. Based on real-world analysis of Latin American health insurance claims.
How Inspector Works
Policy as data
We translate your insurer's coverage rules, formularies, and clinical policies into executable data rules.
Clinical routing + real-time rules
Every dispensing request goes through clinical routing and rule validation before authorization.
Enforce at dispense
Authorization decisions are enforced directly at the point of dispense, not after the fact.
Fingerprint everything
Every decision, exception, and outcome is logged with a full audit fingerprint for compliance.
Real-World Results
43.4% of pharmaceutical spend shows detectable anomalies
Full analysis with 25 detection rules across hundreds of thousands of dispense events from a Latin American pharmacy network.
20.3%
Waste / Utilization
Same-day duplicates, early refills, same-molecule re-authorization within 3 days, same drug family within 7 days, and excessive concurrent medication accumulation
10.8%
Generic Substitution Opportunity
Brand dispensed when a generic alternative is available in Bolivia — 71% of branded products have a generic, but less than 5% is dispensed as generic
7.3%
Clinical Mismatch
Medications with no diagnostic justification, nonspecific diagnoses for targeted therapies, cumulative doses exceeding safe limits, and justifications based only on symptom codes
4.6%
Behavioral Fraud Risk
Incoherent polypharmacy (after 7 clinical exemptions), doctor shopping, cloned prescriptions reused months later, and pharmacy branch dispersion
0.4%
Financial Anomaly
Quantities dispensed exceeding clinical guidelines for the medication
25 detection rules including clinical intelligence, dose validation, prescription clone detection, and generic substitution analysis.
Detection rules validated through structured manual review
Hundreds of thousands of dispense records analyzed across thousands of subscribers from a Latin American pharmacy network
Real-world analysis — Latin American health insurance claims
Recognition
International Innovation Award 2025
Fundación Iberoamericana Alianza del Seguro — Monterrey, Mexico
Inspector AI was recognized as one of the leading innovation projects in the insurance industry, for using advanced analytics, clinical validation, and machine-learning models to help insurers address waste, abuse, fraud, and leakage in pharmaceutical reimbursement processes.
Read more →Frequently Asked Questions
What is WAFL?
How much do insurers lose to pharmacy leakage?
How does Inspector AI detect pharmacy fraud?
Do I need to replace my current systems?
What results can I expect?
How long does implementation take?
Is Inspector AI available in my country?
What is the Innovation Award?
Let us prove it in your data — Free
We’ll load a sample extract into Inspector AI and show what’s slipping through. If there’s nothing there, we walk away.
Request free analysis