CVS Pharmacist Gets $2.6M in Medicaid Whistleblower Lawsuit
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CVS Pharmacist Gets $2.6M in Medicaid Whistleblower Lawsuit

By Kimberly Mirando


Walgreens(LEGAFI) -- A CVS pharmacist has just won $2.6 million for her part in bringing a whistleblower lawsuit against CVS for alleged Medicaid fraud.


When St. Paul CVS pharmacist Stephani LeFlore heard allegations that rival pharmacy Walgreens had been overbilling Medicaid, she wondered if her own employer was doing the same. After some digging, LeFlore uncovered unlawful billing practices at her pharmacy and filed a whistleblower lawsuit in 2008. The U.S. Justice Department later joined the whistleblower lawsuit and ultimately settled last week. CVS Pharmacy, Inc. admitted no wrongdoing but agreed to pay $17.5 million.


It’s the second time in four years that pharmacists in the Twin Cities initiated whistleblower lawsuits that ultimately led to two major pharmacies settling charges about alleged Medicaid overbilling. In 2008, Walgreens paid $9.9 million to settle similar charges brought by a whistleblower pharmacist at a South Minneapolis Walgreens. It was the Walgreens settlement that opened LeFlore’s eyes to her own pharmacy’s billing practices.


LeFlore alleged in the whistleblower lawsuit that the pharmacy where she worked overcharged the state when filling prescriptions for patients who had both Medicaid and private insurance coverage for their medications. In those cases, CVS was supposed to charge the Medicaid program the amount that a patient typically would make as a co-payment under their private insurance. Instead, CVS often collected a larger amount, LeFlore alleged, by billing the state for the difference between the traditional Medicaid payment for a given medication and the discounted rate actually paid by the private insurance company.


As the whistleblower, LeFlore will receive nearly $2.6 million as part of the CVS settlement, the Justice Department said last week. Under the qui tam provisions of the False Claims Act, whistleblowers are entitled to 15 percent to 25 percent of the amount recovered, if the government joins the case. They are also protected under the law from retaliation. LeFlore still currently works for CVS Caremark at an undisclosed location, her lawyer said.



Updated April 20th, 2010

All updates are located in the Qui Tam Whistleblower section of Legafi. 


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