CVS Caremark Corp. will pay $36.7 million to settle allegations that it improperly switched customers to a more-expensive form of a drug paid for by Medicaid, the government program that provides health care to low-income people. A lawsuit alleging fraud by the chain-drugstore company was brought by an Illinois pharmacist and joined by the federal government and 23 states that paid for the medication.
The complaint, filed in 2003 in U.S. District Court for Northern Illinois, alleges CVS pharmacies switched Medicaid patients taking the generic form of stomach medication Zantac to capsules from tablets. Medicaid sets maximum reimbursement prices for the tablet form of the drug but not for capsules, which are more expensive but prescribed less frequently by doctors.
The suit alleges that the switch cost taxpayers as much as 400% more than what would have been paid for tablets. The pill-switching allegedly took place from April 1, 1999, through Dec. 31, 2006.
The case was brought by Bernard Lisitza, who worked as a pharmacist processing CVS prescriptions. Mr. Lisitza previously filed a suit against pharmacy company Omnicare Inc. that settled in 2006 for $50 million. Both suits were filed under the False Claims Act, which allows people to file claims alleging fraud against the government and lets them recover a share of any payments.
Mr. Lisitza received a $6.4 million share of the Omnicare settlement, according to a U.S. Justice Department news release. His attorney, Michael Behn, said his client's share of the CVS settlement will be $4.3 million.
What had me so upset, of course, was that I had not been the one to butcher this cash cow. Almost $11 million dollars this guy gets for taking down 2 corporations,
CVS, which had profit of $2.6 billion on revenue of $76.3 billion in 2007, said the settlement wouldn't have any effect on 2008 earnings.
Make that mildly inconveniencing 2 corporations, and the best I can do is clack away on my keyboard and see that the subject is about as interesting to you as my cat. Sigh.
I admit I do wonder why you don't seem to care that the nation's largest pharmacy chain by store count was gaming the Medicaid system for tens of millions of dollars. Because I sure don't have to go very far into the pharmacy blogosphere to find all manner of vitriol directed against the Medicaid baby momma trying to get some free Tylenol or cold medicine for her child, gaming the system for less than fifty bucks. It's all about wasting the taxpayers money you'll claim. That stupid baby momma should buy her own Tylenol.
Maybe you don't realize that tens of millions is bigger than fifty. Maybe it's time for a visual aid:
$36,700,000 -amount involved in CVS lawsuit.
$50 -amount involved with baby momma.
Or maybe it's not about protecting the taxpayer's money at all. Maybe it's about kicking the people you see as beneath you because it makes you feel better about yourself. Maybe you're afraid to kick upwards because you've been trained to stay in your place. Maybe you're so focused on kicking downwards you don't feel it when your social betters land their foot across your teeth. Or maybe you do feel it, and it just makes you kick down all the harder.
Or you're just really bad at math. One of the two.
21 comments:
thankyouthankyouthankyou!! What CVS is doing is greedy and evil, and should be brought to light. Also, especially, a well deserved burn on some of the more self-righteous bloggers out there.
the baby momma comment sounded like it was directed at the angry pharmacist
Amen Drugmonkey! The story about CVS was news-as-usual, but your commentary putting it in perspective vis-à-vis Medicaid recipients is well-deserved. If people did start questioning their programming, they would kick up instead of down. But what would that do to such a well-ordered invisible caste society? Why... It just might cause some real change in the world.
Mr. Monkey -
You are entirely correct in that Jane and Joe Taxpayer should be more upset about the abuses committed by big pharma in the medicaid system. A few months ago I got into a heated debate with my friends about just how screwed up and easy to work Ohio's system is. One of them was a child of the system - he is no longer. He was particularly upset at how I wanted reform. Since we live in a world where everyone's drugs cost $5.00 (and that's all), it's hard for people to grasp at the concept of something simple like Zantac being expensive.
Ohio Medicaid was requiring brand Zoloft for the longest time. I don't know why. I'm banking on the hope that they had some great setup with Pfizer. But, Mr. Monkey, I ask, what more should I be doing?
Somehow, Spooky seems less upsetting. I don't think she'd try any of these stunts. Plus, I don't have a cat but would like to hear cat stories. I enjoyed the one about the peace treaty your tech negotiated for you by referencing spooky to the old woman. In any case, just because equal amounts of people voted for Spooky and Big Pharma Sludgery doesn't mean we have equal interest in the topics. It just seems Spooky got the most underrepresented.
Ugh. More information, more exposure of these incidents is one way to get people riled up. Keep on keepin' on!
Thanks.
Why didnt the dumbass medicaid just update their formulary. Sounds like its their fault. Private insurance never would have paid a goddamn nickel on it from the beginning.
Thank you for writing this.
I have volunteered as a moderator on a website for neurological/psychiatric medications for many years, and am well aware of the cash price for the meds that keep me alive and not kicking (epileptic humor, heh). Yet, it constantly amazes me how little consideration/little knowledge people seem to have of the actual costs of medications (retail, societal, etc.), and the dirty pol that is often involved in the entire process.
My own insurance is tied to Medicare rates (military), and I have, more than once, been the recipient of the "kicking down" to which you refer. I actually ended up leaving my local "Bullseye" pharmacy when a new pharmacist came in and complained that I didn't deserve a particular medication, because I *only* had X insurance.
Yep, that's right buddy - I don't deserve it. Ass on the line for the US Constitution... but I don't deserve Flonase; hand over the plain ol' Fluticasone Propionate.
D
http://blog.washingtonpost.com/fact-checker/2008/03/hillarys_balkan_adventures_par.html
maybe someone can explain this lawsuit to me in a little more detail...
was there some incriminating cvs memo that said 'pharmacists only use ranitidine capsules we get paid more money that way'? what if the doctor didn't specify tablets/capsules? and why wouldn't the public aid people just change their formularies to either pay for only 1 form of the drug, or to set maximum reimbursement numbers for capsules, too? finally, what company would be dumb enough to hire this guy, who obviously just wants to get on the inside of a company to fuck them over and make a buck>
Dear drug peddeling monkey,
Sure pick on the guy below you picking on a guy below him. If you knew how hard it was for a G.E.D. grad to find someone beneath him to pick on, you would not pick on us for picking on them mr. Mr. Master of Pharmacy. So there.
@Dave: They never came right out and told pharmacists to fill the capsules instead of the tablets. They just set the computer's generic substitution program such that if you put in Zantac, it would auto-sub with the capsules; if you wanted tablets, you had to tell it specifically. (The tablets do come up on the screen, but down near the bottom of the page.) Also they sent capsules from the warehouse, and if you wanted tablets you had to ask for them specifically. Never mind that you can't substitute a different dosage form under the DAW laws, at least in NY. I never understood why they were doing what they were doing: now I know.
I always filled Zantac with the tablets regardless, unless the doctor specified capsules to be dispensed, and made sure that the tablets were in stock in whichever store I happened to work in, whether I had to order them from the outside jobber or not. Had I known the reason they were pushing the capsules, I suspect I'd still have dispensed tablets. "Gaming the system", as you put it, p*sses me off whether it's an individual or a coproation doing it. (typo deliberately left in, 'cuz it fits)
I can foresee a problem for this pharmacist, though: he just made himself unemployable, at least by the chains. Who'd hire him after this? (Of course with that 11 mil, he's probably got enough to open his own store now. Hey, I'd work for him, if I was licensed in Illinois.)
(I thought CVS was #2. Did they pass the big W recently?)
I think the problem is the baby momma situation gets more press. OCR had to pay a lot of money out to Medicaid a few years ago and there was barely a peep of news about it. Now if Britney / Lindsey / Pop Tart du jour was drunk / high / not wearing panties, it would be on tv 24/7. That's considered "news". When a big drug company rips off the taxpayers, it's barely a murmur. Something is definitely screwed up there.
I seem to remember Walgreens doing something similar with generic Fluoxetine caps/tabs when Prozac lost its patent. Might the motivation have been the same?
This was great, thank you so much for sharing this. My family is a recipient of Medicaid (well both of my kids…) We aren’t lowlifes. We aren’t uneducated. And we don’t drive Escalades (try a ’93 Subaru Legacy…) Despite all this, we receive constant judgement simply because we don’t make over 175% of the federal poverty level (sort of on-purpose…..I mean seriously, it is unaffordable to care for two children with chronic health needs without Medicaid…)
Despite having Medicaid for both of my children, I spent 26% of my income on health care & insurance for MYSELF only. But of course, it is easier to kick those who are down, rather than the distinguished suits.
For those interested in filing a False Claims Act case, see the web site of Taxpayers Against Fraud at http://www.taf.org They can hook you up with lawyers who know how to file these types of cases.
These are NOT easy cases to win -- you have to have evidence and the rip-off has to rise to the level of fraud. The U.S. Government only joins about 100 cases a year, and talking to the folks at TAF will give you an idea of whether you have the makings of a case.
P.
Of COURSE we kick those below us! Our feet are down there, not up above, silly monkey!
On a more serious note, it is much easier for the public to "see," and therefore curse, baby momma than it is to picture and shake their fists at CVS. Baby momma is a person, CVS is a faceless entity. The same goes for the relative amounts of money: Fifty bucks? I've SEEN fifty bucks! Tens of millions?? Huh?
You've got to be able to get your arms around something, in order to kick it.
First, thank you for having this blog. In 2006, Medco (MHS - stock ticker) settled w/Feds (medicare) for $155,000,000 for changing prescriptions, falsifying doctor approvals and shorting meds. Unfortunately, Medco continued these practices. In 2007, I almost died as a result of Medco changing, w/o my or Dr approval, live maintaining prescriptions for diabetes. I am currently working w/counsel to bring a suit against Medco. If you have been harmed by Medco, please email me at rmipf@hotmail.com with your information. Whether it is a preferred Class Action or just me, Medco will pay for its behavior. Don't let anyone else suffer or die. And yes, Medco put its arogance in writing, so clear its amazing.
Roger Matlin
rmipf@hotmail.com
Mr. Lisitza and I thank you for your attention to this case. For court documents and further information, please visit www.PharmacyFraudSettlement.com
Folks, while I agree with you 100% that CVS played games here with the system, I do have some comments on the case in general and Mr. Lisitza. First comment has to do with the obvious problem with our government oversight by letting something like this happen in the first place. The US government has thousands or doctors, pharmacist, technicians, and medical professionals in general, that should be reviewing drug lists so that obvious "holes" are not in the system. Is CVS wrong in taking advantage of the system? Sure, but who on this list would not take advantage of the government, if it was in black and white that you could. The goverment screwed up by having this situation exist in the first place. CVS got caught and they paid. Believe me 40 mil to CVS is lunch money.
Now onto Bernie Lisitza. I personally know this man and he is a first class scum bag and if you think he did this for the betterment of us all, think again. Bernie is a pharmacist by trade and owned his own pharmacies for a number of years. Back in the early 90's Bernie was indited with a bunch of other Chicago area pharmacists in an operation called Golden Pill. These pharmacists, were buying samples from drug reps, taking Q-tips and getting rid of the "sample" brand on the drugs and re-packaging them. He was also buying drugs form Mexico, re-packaging them and selling them to his customers. Go ahead and look it up.
Bernie is an oportunist (which I guess is good for him, afterall that is the Americal Way!!) and found a real easy way to make a cool 11 MILLION off of this CVS and Omnicare litigation. That's right folks, this fine gentleman who had no problem ripping off his customers, and the goverment for that matter, is now some kind of hero. Mr. Lisitza may be using this money to feed starving children in Africa, I don't know, but I would not bet any money on it.
I'm pretty sure that is 11 mil tax free.
Pharmguy,
but who on this list would not take advantage of the government, if it was in black and white that you could.
Me. So using your logic you must also not have a problem with Medicaid recipients gaming the system, because it's in black and white that they can.
But CVS got nailed for illegal activity. So, what they were doing must not have been as black and white as you say.
You also make the mistake of assuming that every conflict involves good vs. bad. Many times the truth comes from a case of scumbag vs. scumbag. I have no idea where Mr. Lisitza lies on the scumbag scale, but the fact remains he saved taxpayers a shitload of money and probably taught some bureaucrats a lesson in regulation writing that will pay off in the future. Scumbag vs. scumbag often works to the benefit of us all. Welcome to the American judicial system.
But, what's it all matter? Illinois Medicaid is 8 months behind on reimbursements...
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