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CVS to pay $400k to state over illegal billings to Medicaid

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Indiana Attorney General Greg Zoeller announced Wednesday that CVS has agreed to a settlement to resolve allegations that its pharmacists submitted illegal billings for prescriptions to Medicaid for reimbursement.

The AG’s Medicaid Fraud Control Unit investigated allegations that some CVS pharmacy stores circumvented the Restricted Card Program by filling prescriptions not written by RCP-designated doctors and submitting claims to Medicaid that falsely identified the prescribing physicians as being designated so in order for Medicaid to pay for the drugs, according to a statement from the AG’s office.

The AG’s office did not identify the store locations.

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.

CVS will pay $400,000 and inform its pharmacists and pharmacy technicians of their obligations required under the RCP as part of the settlement.

 

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