AG: Caremark To Pay MassHealth $2.6M For Not Reimbursing Pharmacy Claims

This just in from Massachusetts Attorney General Martha Coakley: Caremark, the national pharmacy benefits manager that also operates mail-order pharmacies, will pay $2.6 million to MassHealth — and $4.25 million in a multistate settlement — for failing to reimburse claims.

Mass. AG Martha Coakley (Wikimedia Commons)

Mass. AG Martha Coakley (Wikimedia Commons)

Here’s the AG’s news release:

A company responsible for processing and paying prescription drug claims will pay $2.6 million to the Massachusetts Medicaid Program (MassHealth) to settle allegations that the company failed to reimburse MassHealth for pharmacy claims paid on behalf of its subscribers, Attorney General Martha Coakley announced today.

Under the terms of the settlement with Massachusetts, Arkansas, California, Delaware, Louisiana and the Department of Justice, Caremark, L.L.C. will pay a total of $4.25 million. The $2.6 million paid to MassHealth represents approximately 63 percent of the total payment by Caremark.

“This settlement is the result of an investigation into allegations that Caremark failed to properly handle and reimburse pharmacy claims for certain customers in the Commonwealth, leaving MassHealth to foot the bill,” AG Coakley said. “Our office will continue to safeguard the taxpayers’ investment in programs designed to provide care and treatment to our most vulnerable citizens.”

Caremark, operated by CVS Caremark Corp., is a California limited liability corporation with its principal place of business located in Illinois. It operates as a Pharmacy Benefit Manager (PBM) throughout the United States and contracts with its client health plans to supply prescription drug distribution and claims processing to participants in the clients’ plans. Caremark also operates mail-order pharmacies, and contracts with retail pharmacies nationwide to dispense prescriptions to its Caremark Plan participants.

This investigation began in 1999 with the filing of a whistleblower lawsuit in United States District Court in San Antonio, Texas. The plaintiff in that case amended her complaint in 2005 to add claims on behalf of the Commonwealth under the Massachusetts False Claims Act.

The investigation reviewed allegations that Caremark improperly rejected, denied or reduced the reimbursement of pharmacy charges. Continue reading

Yes, We’re Now Getting Carded For Nail Polish Remover

(Rachel Rohr/WBUR)

(Rachel Rohr/WBUR)

It was a routine trip to CVS: vitamins and nail polish remover. At self-checkout, I scanned in the nail polish remover and something odd happened.

There was an error message on the screen and a slip of paper printed out that read, “Products containing acetone/iodine cannot be purchased at the self checkout. Please see associate for assistance.”

The saleslady overseeing self-checkout sprang into action and walked over to the register clucking, “New state laws, driving us crazy.” Another sales associate chimed in, “Meth,” and shook her head.

The saleslady asked for my ID. I pulled out my driver’s license. To my surprise, she scanned it into the computer.

How long had it been since I’d bought nail polish remover? Two years? Three? How did I miss this? I’ve been buying nail polish remover since I was probably 13, and painting my nails since I was 8 (quite skillfully, according to my mom).

“What happens if you don’t have a driver’s license?” I asked.

The sales associate shrugged, shook her head and said, “Can’t buy it.” My 13-year-old self cringed. Continue reading