A recent $17.5 million dollar settlement of Medicaid related fraud reinforces the need for strong Whistleblower protections, and how one single employee can make a difference in exposing fraud and recovering tax dollars for the government.
The Whistleblower lawsuit was filed against CVS Pharmacy Inc. in 2008 by a company employee who suspected CVS Pharmacy of overcharging in her branch. The suit was later joined by the Justice Department, and 10 other states. The lawsuit alleged that CVS overcharged when filling prescriptions for patients who had both Medical Assistance and private insurance coverage for their medicines. CVS was supposed to charge the Medical Assistance program the amount that a patient typically would make as a co-payment under their private insurance. In August 2008, the store filled a prescription for which the Medical Assistance program should have been billed just $22. Instead, CVS billed the state $26.75, the lawsuit alleged. CVS settled the cases against them totaling $17.5 million but did not admit wrongdoing. In addition, the settlement agreement requires CVS to comply with an amended corporate integrity agreement with the Office of the Inspector General of the United States Department of Health and Human Services, which is intended to prevent recurrence of its conduct.