Caremark LLC, a pharmacy benefit management company that is operated by CVS Caremark Corporation, has agreed to pay the government $6 million to settle allegations it knowingly failed to reimburse Medicaid for prescription drug costs paid on behalf of beneficiaries who were also eligible for drug benefits under private health plans administered by Caremark, according to the Department of Justice.
Caremark served as the pharmacy benefit management company for private health plans who insured a number of dual eligibles, and under the law, the private insurer, rather than the government, must assume the costs of healthcare for dual eligibles.
According to the lawsuit filed against Caremark, the company's RxCLAIM computer platform did not pay the full amount owed on certain claims. The government alleged the platform improperly deducted certain co-payment or deductible amounts when calculating payments, which caused Medicaid to incur the costs for prescription drugs for dual eligibles rather than Caremark-administered private health plans.
The lawsuit was originally filed by a former Caremark employee under the qui tam, or whistle-blower, provision of the False Claims Act.
Although Caremark agreed to settle this case, there has been no admission of guilt.
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