CVS To Pay $895,000 To Settle Massachusetts Medicaid Billing Claims
CVS has agreed to pay MassHealth, Massachusetts' Medicaid program, $895,000 to settle claims that the pharmacy chain failed to reimburse the state for prescriptions that were ordered but only partially filled or not filled at all, the Providence Journal reports. The case involves prescription orders made by MassHealth beneficiaries between 1996 and 2005 (Barmann, Providence Journal, 7/26). Under regulations, when a prescription for a MassHealth beneficiary is filled by a pharmacist, a claim for reimbursement is sent to the program at the same time. However, if the prescription is not picked up, the pharmacy must return the payment to MassHealth within 60 days of receiving it (Armstrong, Wall Street Journal, 7/25). The Massachusetts attorney general's Medicaid Fraud Control Unit found that CVS failed to return payment for some MassHealth prescriptions that were not picked up, according to David Marks, deputy chief of the fraud unit. A previous investigation of CVS found similar problems. In 1998, the state and the pharmacy chain reached a settlement in which CVS agreed to procedures for returning money to Medicaid for partially filled prescriptions. Marks said CVS subsequently failed to comply with the procedures. However, Eileen Dunn, vice president of corporate communications at CVS, denied wrongdoing and said the issue was the result of a billing problem related to MassHealth's online claims-processing system. After negotiations between the two sides failed, they agreed to take the matter to the Medicaid Fraud Control Unit. Dunn said that nearly all the claims involved in the matter were issued before 2002, and CVS and MassHealth since have updated their computer systems to be able to reverse claims electronically (Providence Journal, 7/26). As part of the settlement, CVS has agreed to monitor its MassHealth billings and repay the state promptly in similar cases (Wall Street Journal, 7/25).
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