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News and Analysis of Medicaid Fraud: Retail Pharmacy Giant CVS to pay $17 Million for Incorrect Billing Practices

Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for above-the-bar-logo-no12.jpgOur Employee Whistleblower Attorneys have been closely following a whistleblowing claim against CVS, the national retail pharmacy chain. A pharmacist brought a whisteblower complaint alleging that CVS submitted inflated prescription claims in approximately 10 states (California, Florida, Indiana, Massachusetts, Michigan, New Hampshire, Nevada, Rhode Island, Alabama and Minnesota). It was alleged that CVS received higher reimbursement rates from Medicaid than if had complied with correct billing procedures and submitted the claims to third-party insurers. Specifically, it was alleged that CVS overcharged Medicaid by filling prescriptions for customers who also had other insurance. In those situations, CVS was supposed to bill Medicaid only for a patient’s copayment. As a result of the whistleblowing claim and the ensuing investigation, CVS has agreed to pay $17 million and to have its billing procedures monitored for the next three years. The pharmacist employee who blew the whistle will collect $2.5 million as part of the whistleblower claim.

Warning Bell For Companies in Healthcare Industry

Warning other companies who defraud the Medicaid system, Daniel Levinson, inspector general of the U.S. Department of Health and Human Services stated that “[m]edicaid covers the poorest, most vulnerable people in American society. This needed government program for prescriptions is a disservice to everyone and won’t be tolerated.” For many years, our Workplace Fraud Attorneys have been advising pharmacists, doctors, physicians, nurses, physician assistants, companies and individuals regarding their rights and opportunity to collect reward for reporting Medicaid fraud. If you see fraud in the workplace, report it to our office and whistleblower hotline.

Some Common Examples of Medicaid Fraud

Below are some of the most common methods used to defraud the Medicaid Program:

• Billing for “phantom patients” who did not really receive services • Billing for medical services or goods that were not provided
• Billing for tests that the patient did not need or receive • Paying a “kickback” in exchange for a referral for medical services or goods • Overcharging for health care services or goods that were provided • Concealing ownership in a related company • Using false credentials and/or using one Medicaid provider number to bill services
for many individuals
If you know of any fraudulent practices in your workplace or anyone that is defrauding the Medicaid program, contact our Whistleblower and Medicaid Fraud Attorney for a free confidential consultation at (800) 893-9645 and learn how to report the fraud.


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