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CVS, Indiana AG announces $400K settlement

By Bryan Cohen | Feb 15, 2013

INDIANAPOLIS (Legal Newsline) - Indiana Attorney General Greg Zoeller announced a $400,000 Medicaid settlement Wednesday with CVS Stores to resolve allegations of illegal billings for prescriptions to Medicaid for reimbursement.

Under the terms of the settlement, Hook-SupeRx, also known as CVS Stores, agreed to pay the state's Medicaid program $400,000 and to inform its pharmacy technicians and pharmacists of their obligations required under Medicaid's Restricted Card Program.

"Prescription drug abuse by addicted patients is an epidemic problem in our state so it's important that pharmacies comply with existing laws for responsible dispensing and billing," Zoeller said. "Those who submit false billings to the Medicaid program and are paid more than they are due will ultimately be required to repay the state of Indiana."

The RCP gives limited access to Medicaid patients whose drug usage indicates abuse and gives only certain physicians the ability to prescribe medications for them. The program will not typically give pharmacies reimbursement from Medicaid if a designated physician has not ordered the prescription for an RCP patient.

Zoeller's Medicaid Fraud Control Unit alleged that between January 2001 to the present, certain CVS pharmacy stores circumvented the RCP by filing prescriptions not written by RCP-designated physicians and submitting claims to Medicaid falsely identifying the prescribing doctors as RCP-designated to ensure Medicaid would pay for the drugs.

Under the terms of the settlement, CVS must institute a written policy program for its pharmacy technicians and pharmacists to become compliant with the RCP, now called the Right Choices Program.

The settlement resolves allegations without CVS admitting liability.

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