CVS Pharmacy has agreed pay $17.5 million to settle a false Medicaid billing case. The settlement, brought to the government's attention by a Minnesota pharmacist resolves allegations the company submitted inflated prescription claims in 10 states for more than what was owed to CVS for Medicaid beneficiaries who were also eligible for benefits under a primary, third-party plan.
Under the terms of the settlement CVS will pay the federal government nearly $8 million and more than $9.5 million to the ten states. States that will receive a part of the settlement include Alabama, California, Florida, Indiana, Massachusetts, Michigan, Minnesota, New Hampshire, Nevada and Rhode Island. The CVS pharmacist who brought the allegations under the whistleblower False Claims Act will receive nearly $2.6 million as a part of the settlement.
New Jersey's Medicaid program won a $300 million federal grant to help fund coverage for more than 57,000 childless adults earning up to 25 percent of the poverty level. The grant will pay for 50 percent of the program through 2013 and will allow the state to continue coverage for this population. "This demonstration is yet another example of the many flexibilities states have to adapt their Medicaid programs to better serve their residents," said Health Secretary Kathleen Sebelius. "I want to commend New Jersey for expanding coverage to people in need." The matching grant is one of the first steps as New Jersey looks to revamp its Medicaid program. New Jersey is also seeking a global Medicaid waiver that it says could save the state an additional $300 million.
Nearly half of the people in Pennsylvania dropped from the state's AdultBasic health insurance plan received letters saying they may qualify for Medicaid, according to a report in the Philadelphia Inquirer. Based on income data, more than 19,000 of the 41,000 low-income adults dropped from the program received letters from the state informing them of their potential eligibility for the program. Pennsylvania dropped the AdultBasic program about in early March saying funding for the program had dried up. AdultBasis was created to provide insurance coverage for low-income adults who didn't qualify for Medicaid. It was partially funded by money from the landmark tobacco settlement of 1998, money the state auditor recently contended was diverted to other state budget items.