CVS to pay $400K to resolve illegal billings to Medicaid
From the article:
The $400,000 settlement announced this week resolves the allegations without CVS admitting liability
Through the Restricted Card Program, Medicaid patients whose drug usage indicates abuse are given limited access to prescriptions and only certain physicians are permitted to prescribe medications for them. Under the RCP, pharmacies typically will not receive reimbursement from Medicaid if a designated physician has not ordered the prescription for an RCP patient.
The Attorney General’s Medicaid Fraud Control Unit investigated allegations that certain CVS pharmacy stores circumvented the Restricted Card Program by filling prescriptions not written by RCP-designated physicians and submitting claims to Medicaid that falsely identified the prescribing doctors as being designated so that Medicaid would pay for the drugs.
These particular Medicaid pts have been designated as “drug abuser” by the Medicaid system and the restricted card is plainly marked that the pt is restricted to a single prescriber and single pharmacy. Any pharmacy that tries to submit a Rx claim for a restricted patient when it is not written by the physician the patient is restricted to and/or the pharmacy is not the pharmacy that the patient is restricted to.
It is not clear, from the article, how many of the CVS stores and/or Pharmacists were involved in this illegal activity. Was this just the act of the rogue Pharmacist(s) in one store trying to generate sales to meet their sales and/or bonus goals or was this pressure put on Pharmacists at the store level from up the corporate ladder to up sales revenue ?
Why would one believe that if these Pharmacist(s)/store(s) were doing this with a restricted program.. that they were not doing the same thing with any controlled Rx that came in the door.
Remember the issue with the DEA and two CVS stores in Sanford, FL a year ago http://www.wftv.com/news/news/local/dea-releases-more-information-sanford-cvspharmacy-/nHWSx/
Isn’t it illegal to knowingly support the habit of a addict and/or knowing or should have known that controlled substances dispensed would be diverted to “the street” ?
It was my understanding that anytime that the FEDS busts a drug dealer that they seize all the property and money belonging to the drug dealer… I guess it depends on what the drug dealer has/owns that the FEDS can make use of….
02/26/2013 update.. I have been told from a very reliable source that the Indiana BOP is taking no action against the RPH nor the permit holder.. considers this just a Medicaid issue
Filed under: General Problems
The pharmacists had to keep up their script count or lose even more tech help. The new system demands more of pharmacists and more activities are tracked even how many seconds spent on a phone call. All under the guise of patient care.
Yes, this is a strange one! Why is CVS being fined? What about the pharmacists that filled those prescriptions? I would say the pharmacists are to blame. Surely their software shows who did what and the board can identify the pharmacists that broke the law. I am not saying that CVS is has no blame, because what do we know that the DM said to the pharmacists? But, no matter what the pharmacists were told by CVS, they should not have broke the law and they should be held responsible. And, as Steve says, those pharmacists are essentially ‘drug dealers’. We don’t need these kinds of pharmacists in our profession. They should be booted out!
Back to CVS, if they ordered pharmacists to fill those prescriptions, then the pharmacists should be punished and the CVS people up the hierarchy at CVS should go to jail. It is strange that CVS always gets away with a fine and in most instances not even a confession of guilt. Just shows how crooks with money can get away with anything.
ps…check out the section on “Greater Protection for Benificiaries”:
http://www.cms.gov/apps/media/press/release.asp?Counter=4540&intNumPerPage=10&checkDa
Maybe the CMS has some teeth?
400,000 puny bucks…I am not impressed. I am sure the pharmacy staffs are history since the employees are disposable. The intense emphasis on speed and the pressure to increase script count (make those adherence calls) has caused the abandonment of good judgement. Most pharmacists for this chain are not as concerned about their bonus as they are about constant harassment from management.