The most interesting part about a whistleblower with this type of information is there is not much gray area. The PBM either overbilled Medicaid, or Medicare, or they did not
(PRWEB) October 16, 2014
The Corporate Whistleblower Center is urging managers or insiders at a pharmacy benefit management company to call them immediately at 866-714-6466 if they have proof a PBM is involved in knowingly billing Medicaid or Medicare for pharmacy bills that should have been paid by a private insurance company. As the Whistleblower Center would like to explain, this type of information from a insider can produce a million dollar reward.
In September of 2014 the Justice Department announced Caremark L.L.C., a pharmacy benefit management company (PBM), will pay the United States $6 million to settle allegations that Caremark allegedly failed to reimburse Medicaid for prescription drug costs paid on behalf of Medicaid beneficiaries who also were eligible for drug benefits under Caremark-administered private health plans. Caremark is operated by CVS Caremark Corporation, one of the largest PBMs and retail pharmacies in the country.
When an individual is covered by both Medicaid and a private health plan, the individual is called a “dual eligible.” Under the law, the private insurer, rather than the government, must assume the costs of health care for dual eligibles. If Medicaid erroneously pays for the prescription claim of a dual eligible, Medicaid is entitled to seek reimbursement from the private insurer or its PBM. A PBM administers and manages the drug benefits for clients who offer drug benefits under a health insurance plan.
Caremark allegedly served as the PBM for private health plans who insured a number of individuals receiving prescription drug benefits under both a Caremark-administered plan and Medicaid. According to the government, Caremark’s RxCLAIM computer platform allegedly failed to pay the full amount due on certain claims because it allegedly improperly deducted certain co-payment or deductible amounts when calculating payments. The government alleged that Caremark’s actions caused Medicaid to incur prescription drug costs for dual eligibles that should have been paid for by the Caremark-administered private health plans rather than Medicaid.
The Corporate Whistleblower Center says, "If you are a manager, or accountant at a pharmacy benefit management company, and you know your company is knowingly overbilling Medicaid, or Medicare for pharmaceutical products please call us at 866-714-6466 so we can carefully explain how federal whistleblower programs work. The most interesting part about a whistleblower with this type of information is there is not much gray area. The PBM either overbilled Medicaid, or Medicare, or they did not.
"If you possess this type of information we will help you package your information, and then we will get you to the best whistleblower attorneys in the nation. No other group in the nation offers a comparable service." http://CorporateWhistleblowerCenter.Com
In instance the PBM whistleblower will receive $1.02 million dollars.
Simple rules for a whistleblower from the Corporate Whistleblower Center:
- Do not go to the government first if you are a major whistleblower. The Corporate Whistleblower Center says, “Major whistleblowers frequently go to the federal government thinking they will help. It’s a huge mistake.”
- Do not go to the news media with your whistleblower information. Public revelation of a whistleblower’s information could destroy any prospect for a reward.
- Do not try to force a government contractor or corporation to come clean to the government about their wrongdoing. The Corporate Whistleblower Center says, “Fraud is so rampant among federal contractors that any suggestion of exposure might result in an instant job termination, or harassment of the whistleblower. Come to us first, tell us what type of information you have, and if we think it’s sufficient, we will help find the right law firms to assist in advancing your information.”
- The Corporate Whistleblower Center wants to emphasize there are high quality whistleblowers in every state including California, New York, Florida, Texas, Massachusetts, Maryland, Rhode Island, Virginia, Ohio, Pennsylvania, West Virginia, Tennessee, North Carolina, Georgia, Alabama, Louisiana, Missouri, Michigan, Indiana, Iowa, Illinois, Wisconsin, Minnesota, Nebraska, North Dakota, Kansas, New Mexico, Colorado, Utah, Arizona, Nevada, Idaho, Washington, and Alaska.
Any type of insider or employee who possesses significant proof of their employer or a government contractor defrauding the federal government is encouraged to contact Corporate Whistleblower Center anytime at 866-714-6466 or via their web site at http://CorporateWhistleblowerCenter.Com
For attribution purposes please refer to the September 2014 United States Department of Justice press release on this matter. http://www.justice.gov/opa/pr/caremark-will-pay-6-million-resolve-false-claims-act-allegations
Case number: The case is captioned United States ex rel. Well v. CVS Caremark, Inc., Civil Action No. SA:11-CV-00747 (W.D. Tex.).