Friday, May 27, 2005
|Lawsuit against Caremark, Inc.|
We intend to send Caremark a past-due bill for its conduct, said Attorney General Abbott. This company schemed to avoid responsibility for its health care obligations to members who were paying premiums. Instead it opted to let the Medicaid program and Texas taxpayers cover expenditures it should have covered on behalf of those already insured under its plan. I intend to get those dollars back for Texas.
A pharmacy benefit manager administers prescription drug benefit plans for insurance companies, employers, managed care organizations and other entities. In doing so, they strive to keep costs low for these clients, sometimes by illegal means.
The suit, also joined by the federal government and the states of Tennessee, Florida and Arkansas, tracks a systematic effort by Caremark to allow Medicaid to pick up the tab for medications acquired by families who were dually covered by both Caremark and Medicaid. State and federal law require health benefit plans to reimburse Medicaid when a claim covered by insurance is paid for by Medicaid.
The practices were brought to light in a 1999 sealed whistleblower lawsuit filed by an employee of Caremark, whose job involved the review of claims processing. The employee complained to the company that legitimate government requests for reimbursement for these unlawful practices were being rejected, but company officials ignored her. She then filed suit on behalf of the state of Texas and the federal government in a civil action known as a qui tam, which entitles the whistleblower to a percentage of damages collected if the case succeeds.
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