US Department of Justice Joining States in Lawsuit Against PBM Caremark Over Improper Reimbursements

Main Category: Medicare / Medicaid / SCHIP
Article Date: 02 Jun 2005 - 13:00 PDT

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The US Department of Justice is joining Arkansas, Florida, Tennessee and Texas in a whistleblower lawsuit against pharmacy benefit manager... Caremark Rx that alleges the company sometimes improperly reimbursed state Medicaid and other federal health insurance programs, the AP/Jackson Clarion-Ledger reports. The lawsuit, filed by former Caremark employee Janaki Ramadoss in U.S. District Court in San Antonio, accuses Caremark of knowingly avoiding or decreasing reimbursements for medications when beneficiaries were dually covered by Medicaid and Caremark. Caremark allegedly allowed Medicaid to fully cover medications in such dual coverage situations since 1999, according to the lawsuit. According to the AP/Clarion-Ledger, in dual-coverage situations, Medicaid or other public health insurance coverage is considered secondary to coverage under a private plan. DOJ officials said they plan to serve the complaint to Caremark within 120 days. In a statement, Caremark officials said the company "strenuously refutes the claims." Caremark spokesperson Gerard Carney said, "As a pharmacy benefit manager, Caremark believes the plaintiffs are seeking to impose payment obligations on Caremark that are neither appropriate or required by law" (AP/Jackson Clarion-Ledger, 6/1).

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