Mercy Medical Center, a 262-bed nonprofit, university-affiliated teaching hospital based in Baltimore, has long relied on its 340B Drug Pricing Program as a critical funding mechanism for charitable care and community health initiatives.
As a disproportionate share hospital serving a high proportion of low-income and underinsured patients, Mercy’s 340B savings directly support its mission. But as claim volumes grew and the regulatory environment became more complex, the hospital’s manual approach to compliance auditing reached its breaking point.
Complexity drives innovation
Mercy Medical Center’s 340B program spans in-house, contract, and mixed-use pharmacy operations across more than 30 clinic locations, multiple third-party administrators, and an increasingly dynamic regulatory landscape. Much like the majority of the industry, the team’s longstanding reliance on manual spot audits could not scale with rising claim volumes.
Provider attribution and location logic posed particular challenges. Because providers frequently work across both eligible and non-eligible sites, claims require consistent location matching to be adjudicated correctly. Identifying misclassified claims at scale through manual review alone was nearly impossible.
Achieving full audit coverage would have required significant additional full-time staff, a costly and difficult proposition in today’s tight labor market.
“Every decision we make has the patient and compliance at the forefront,” said Greg Smith, chief pharmacy officer at Mercy Medical Center.
Automation creates ‘peace of mind’
Mercy Medical Center implemented Plenful’s 340B Audit & Optimization suite to automate compliance auditing and recapture high-value claims across its entire program. The platform replaced manual sampling with continuous coverage of 100% of 340B-eligible claims, eliminating blind spots and strengthening compliance rigor.
Plenful’s configurable rule-based logic proved especially valuable in addressing provider location challenges. The system flags high-risk claims into a centralized task management queue, automating nearly all of the manual work previously required to surface mismatches.
“The peace of mind that Plenful brings — knowing that there’s a set of eyes on 100% of our claims — has really changed the way 340B functions at Mercy Medical Center,” said Shane Gabriszeski, 340B compliance officer at Mercy Medical Center.
That shift has translated into greater organizational confidence across Mercy’s 340B governance committee, which includes physician leadership, finance, risk, and corporate compliance.
The platform’s 360 Executive Dashboard gives leadership a centralized view of program performance, audit activity, and savings and serves as a single source of truth that consolidates fragmented data into actionable insights.
Recapturing missed savings at scale
Beyond compliance, Plenful’s Missed Opportunities solution enables Mercy Medical Center to identify and recapture 340B savings from claims incorrectly assigned as ineligible by third-party administrators. By processing millions of rows of encounter, dispensing and location data, the platform surfaces revenue that would have been impossible to identify manually.
Since the partnership launched in 2025, Mercy has recaptured savings from more than 6,000 claims previously marked as ineligible.
Just as importantly, automation has redirected staff time toward higher-value work, including reviewing flagged claims, uncovering additional savings opportunities and advancing overall program strategy.
Key results
- 100% automated audit coverage across all 340B-eligible claims
- 33-times increase in audit capacity
- Recaptured savings from more than 6,000 claims previously marked ineligible
- Improved executive visibility through centralized reporting dashboards
Looking ahead
Mercy Medical Center and Plenful are expanding their partnership to implement Plenful’s Rebate Management Solution, positioning the health system to stay ahead of regulatory changes while maintaining the same high standard of compliance and patient care.
“Plenful helps me sleep at night, knowing our 340B program is compliant,” said Thomas Kim, director of performance improvement at Mercy Medical Center.
To read the full case study click here.
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