CVS to pay $6M to settle Medicaid reimbursement case

Caremark LLC, a unit of CVS, will make the payments to settle allegations that it knowingly failed to reimburse Medicaid for prescription drug costs paid on behalf of patients who were also covered by private plans it administered. The company denied wrongdoing.

The Wall Street Journal: CVS Settles Medicaid Reimbursement Charges
CVS Health Corp. agreed to pay $6 million to settle allegations its pharmacy benefit manager failed to reimburse Medicaid for some prescription drug costs, the U.S. Department of Justice said Friday. Caremark, operated by pharmacy giant CVS, handles pharmacy benefits for a number of "dual eligible" individuals who receive prescription drug benefits under both a Caremark-administered plan and Medicaid. Under the law, the private insurer must assume the costs of health care for dual eligible (Dulaney, 9/26).

Reuters: CVS' Caremark Unit Settles U.S. False Claims Allegations
Caremark LLC, a unit of CVS Health Corp , will pay $6 million to settle U.S. allegations that it knowingly failed to reimburse Medicaid for prescription drug costs paid on behalf of patients who were also covered by private health plans it administered. The settlement announced on Friday by the U.S. Department of Justice resolves claims that Caremark, a pharmacy benefits management company, violated the federal False Claims Act by improperly processing claims of such "dual eligible" patients. Donald Well, a former Caremark employee who brought the case to the government's attention, will receive $1.02 million plus interest under the law's whistleblower provisions. CVS spokeswoman Christine Cramer said the Woonsocket, Rhode Island-based company settled to avoid protracted litigation, and denied wrongdoing. She also said the accord does not involve its pharmacy or Medicare Part D businesses (Stempel, 9/26).