BluePeak was established in 2010 and has a team of consultants that consists of senior-level managed care and Medicare/Medicaid pharmacy professionals, experienced auditors, clinicians and former CMS regulators who have worked at health plans, pharmacy benefit managers (PBMs), and CMS for the majority of their careers. Our expertise lies in health plan Medicare/Medicaid compliance; CMS Parts C and D program audits, mock audits and validation audits; Medicare/Medicaid Part C and D operations; PBM contractual audits and compliance; PBM oversight; and remediation of all compliance and operational issues.
About 90 percent of our business is with health plans and PBMs, with a focus on compliance audits and operations. BluePeak has worked with most of the top PBMs and over 120 health plans. In 2017, we supported eight clients during live CMS program audits, as well as conducted many mock audits using current CMS audit protocols. We are currently working on our first three live 2018 CMS audits. Since 2013, BluePeak has conducted over 150 CMS mock audits and onsite support projects for clients undergoing actual CMS program audits.