According to an excerpt from this Justice Department news release -
The settlement resolves allegations that CVS submitted inflated prescription claims to the government by billing the Medicaid programs in Alabama, California, Florida, Indiana, Massachusetts, Michigan, Minnesota, New Hampshire, Nevada and Rhode Island for more than what CVS was owed for prescription drugs dispensed to Medicaid beneficiaries who were also eligible for benefits under a primary third party insurance plan (excluding Medicare as the primary payor). The United States alleged that rather than billing the government for what the insured would have been obligated to pay had the claims been submitted solely to the third party insurer (typically the co-pay), CVS billed and was paid a higher amount by Medicaid.
So, who turned in CVS to the Feds? Smart front line pharmacist Stephani Leflore, of St. Paul, Minn., who started as an overnight CVS pharmacist in 2008.
I wonder if she is like many other chain pharmacists who've gotten fed up with the prescription redlining and time guarantees, the overburdening workload and constant rush to fill prescriptions quickly, the increasing requirement of having to answer to non-pharmacists, the rapidly diminishing power over their professional destiny.. and having to pay for Medicaid fraud out of their own taxes?
Now, it's not like Stephani didn't try to do the right thing and alert her supervisors of the alleged over-billing beforehand. According to Claudine Homolash, a partner with Sheller, P.C. who specializes in whistleblower, pharmaceutical, and consumer protection litigation -
Ms. LeFlore claimed in her federal and state lawsuits that CVS should only have billed the Medicaid program the same limited co-pay on prescriptions that it would have normally billed the customer under the insurance plan. She alleged that CVS designed a billing software program for its pharmacies that consistently overcharged Medicaid on these co-pays. She claimed that these overcharges occurred on hundreds of thousands of prescription sales for well over five years.
Ms. LeFlore first complained internally, but she was told by a supervisor that “corporate took care of the billing” and that she need not be concerned.
So, if you ask me, what else could a conscientious, responsible, and ethical pharmacist do but to empower herself and turn whistleblower? Wouldn't you do the same?
