A settlement has been reached in a whistleblower class action lawsuit brought against Caremark LLC who is accused of knowingly failing 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 Corp.
The federal government will receive approximately $2.31 million and five states – Arkansas, California, Delaware, Louisiana and Massachusetts – will share $1.94 million under the settlement agreement. The whistleblower will receive approximately $505,680 from the federal government’s share of the settlement.
Filed in 2012, the government's complaint alleged that Caremark used a computer claims processing platform called “Quantum Leap” to cancel claims for reimbursement submitted by Medicaid for dual eligibles. The complaint further claimed 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.
