Wednesday, May 4, 2011

Justice From The Front Lines

From the Department of Justice: CVS Pharmacy Inc. Agrees to Pay $17.5 Million to Resolve False Prescription Billing Case.

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?


  1. According to the FBI Eastern District in Michigan, Kmart Corporation to Pay U.S. More Than $2.5 Million to Settle False Claims Act Allegations for Partially Filled Prescriptions.

    Kmart is alleged to have violated the False Claims Act by billing government health care programs (Medicaid, Tricare, and the Federal Employee Health Benefits Program) for all drugs included in a prescription when, for many prescriptions, it dispensed only a portion of the prescribed drugs. Although billed in full to the government health care programs, the remaining portion of the prescriptions were never dispensed to beneficiaries and were later returned to stock.

    A portion of the settlement amount will go to Mark Kirsch, to settle the qui tam or “whistleblower” complaint against Kmart Corporation. Kirsch, a former Kmart traveling pharmacist who filed the action in Detroit in the Eastern District of Michigan, will receive $309,687.

  2. Omnicare Inc. agreed to pay $120 million to settle a whistle-blower lawsuit claiming it violated the U.S. anti-kickback law by giving discounts on certain Medicare services to nursing homes.

    The company was accused in the lawsuit of providing the discounts in exchange for referrals of patients with government-reimbursable drug costs. The case, filed in 2010 by former Omnicare pharmacist Donald Gale, was set to begin trial next week in federal court in Cleveland.

    Read more at: Omnicare Agrees to Pay $120 Million Over Kickback Claim

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