Medicaid

September 26, 2014

Pharmacy benefit management (PBM) company Caremark LLC agreed to pay $6 million to settle charges of failing to reimburse Medicaid for prescription drug costs that should have been paid for by Caremark-administered private health plans.  Caremark is operated by CVS Caremark Corporation, one of the largest PBMs and retail pharmacies in the country.  Donald Well, former employee of Caremark, will receive a whistleblower award of $1 million from the $6 million False Claims Act settlement. DOJ

September 18, 2014

New York Attorney General Eric T. Schneiderman announced that 46 states and the District of Columbia have reach a settlement agreement with Minnesota-based company Medtronic to resolve claims under the False Claims Act that Medtronic improperly induced physicians to recommend Medtronic devices to treat cardiac rhythmic disease. New York led a national team composed of members from Oregon, Texas and California to negotiate the settlement. The federal government settled its matter in May of this year. The agreement requires Medtronic to pay the settling states $362,362 which will go to those states’ Medicaid programs. The matter was brought by a whistleblower, Adolfo Schroeder. NYAG

August 6, 2014

New York Attorney General Eric T. Schneiderman announced he, along with 40 other state Attorneys General and the District of Columbia, reached a $35M settlement with Pfizer arising from alleged improper marketing and promotion of the immunosuppressive drug Rapamune. New York’s share of the settlement is over $1.7M. Pfizer, as parent of Wyeth Pharmaceuticals Inc., agreed to be bound by the judgment and to resolve allegations that Wyeth unlawfully promoted Rapamune. Attorney General Schneiderman’s office served on the Executive Committee of this multi-state investigation. NYAG

January 5, 2014

New York Attorney General Eric T. Schneiderman announced that Apple Transportation of New York, Inc. will pay $300,000 to settle claims it overbilled Medicaid for transportation services. As part of a settlement agreement, Apple Transportation admitted that between January 1, 2004 and October 30, 2008, it frequently billed Medicaid for ambulette services even though no personal assistance was provided to Medicaid recipients. As a result, Apple was paid by Medicaid for ambulette services at rates that were higher than the applicable livery rates. NY