E/M Coding Alert - 2003 Issue 39
PBMs: CHARGES PILE ON IN MEDCO WHISTLEBLOWER SUIT
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Article Overview
This article covers a False Claims Act matter involving a pharmacy benefits manager and multiple whistleblower complaints, along with the Department of Justice’s intervention and the expansion of allegations to additional Medicaid-related claims. It is relevant to readers tracking health care fraud enforcement, government program integrity, and litigation involving pharmacy benefit management companies and prescription drug transactions.
Why This Topic Matters
It matters because it highlights how federal and state payers can become the focus of fraud enforcement actions involving prescription drug claims, program administration, and alleged kickback activity. Compliance, legal, audit, and pharmacy reimbursement professionals may use this to understand the general enforcement landscape and the types of allegations that can arise in PBM-related litigation.
What You Will Learn
- The article’s focus within a government fraud and whistleblower litigation context
- Which health care programs are implicated at a high level
- How the dispute expanded from federal allegations to additional state Medicaid claims
- Why PBM-related activity can attract scrutiny from enforcement authorities
Who Should Read This
- Health care compliance professionals
- Medical coders and billing staff
- Pharmacy benefit management professionals
- Health care attorneys
- Fraud and abuse investigators
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