Latest news with #Tricare
Yahoo
10-07-2025
- Business
- Yahoo
CVS Omnicare ordered to pay $949 million in government fraud case
This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. A federal judge has ordered CVS to pay $948.8 million in penalties and damages in a whistleblower case alleging that the company's Omnicare division illegally charged the U.S. government for prescription drugs. Manhattan Judge Colleen McMahon imposed a $542 million penalty for what she called 'very big fraud' in her Monday order, and awarded $406.8 million in damages — three times the $135.6 million that a jury awarded in the spring, as required under the False Claims Act. Omnicare filed more than 3.3 million false claims between 2010 and 2018, according to court documents. CVS, which acquired the pharmacy benefits manager in 2015, denied the allegations and said it planned to appeal McMahon's decision. A former Omnicare pharmacist filed the lawsuit in 2015 accusing the PBM of improperly billing Medicare, Medicaid and the military's Tricare program for over $135 million in drugs that weren't actually covered by the programs. Omnicare — the largest long-term care pharmacy services provider in the U.S. — fraudulently dispensed drugs to elderly and disabled people in long-term care and assisted living facilities without valid prescriptions, according to the complaint. The Department of Justice joined the suit in 2019, and a jury ruled in favor of the government last spring. The False Claims Act allows whistleblowers to bring complaints on the government's behalf and share in potential damages. The law is a key weapon in the government's arsenal for combating fraud, and the driving force behind a major share of healthcare recoveries. The law requires tripling of damages, a stipulation that inflated CVS' penalty. The company argued that the $948.8 million award violates the Constitution's prohibition against excessive fines, but McMahon did not agree. 'Admittedly [the fine] is a very big number. But this was a very big fraud on the Government, one that lasted over almost a decade, and one that Omnicare was aware of but avoided taking steps to correct,' the judge wrote. And CVS is getting off relatively easy, McMahon noted. According to her order, following the letter of the FCA, which outlines a minimum penalty of $5,000 for every false claim, would result in an 'astronomical' minimum penalty of $26.9 billion on top of the damages. Still, CVS plans to appeal the judgment. 'This lawsuit centered on a highly technical prescription dispensing record keeping issue that was allowed by law in many states. The dispensing practices referenced were limited to Omnicare, ended in 2018, were used by many others in the industry at the time, and were accepted by CMS,' a spokesperson for the company said. 'There was no claim in this case that any patient paid for a medication they shouldn't have or that any patient was harmed. The decision on penalties is unconstitutional, especially given the fact that there is no evidence that a single patient suffered harm,' they added. If the healthcare juggernaut's appeal fails, the penalty is small hit in comparison to its annual revenue, which reached $372.8 billion in 2024. Still, it would mean a financial speedbump for CVS, which is struggling to adjust to reimbursement pressures in its legacy retail pharmacy business and higher medical costs for members in its Aetna health plans. Recommended Reading DOJ charges more than 300 in $14.6B healthcare fraud bust
Boston Globe
10-07-2025
- Business
- Boston Globe
CVS ordered to pay $949m over invalid prescriptions in federal lawsuit
Omnicare specializes in providing services to assisted-living communities, nursing homes, and other long-term care settings. The acquisition was CVS's attempt to broaden its presence in the specialty pharmacy business as it sought to capitalize on an aging population. Omnicare is now the largest long-term care pharmacy services provider in the country. Get Rhode Map A weekday briefing from veteran Rhode Island reporters, focused on the things that matter most in the Ocean State. Enter Email Sign Up Uri Bassan, a former Omnicare pharmacist in Albuquerque, N.M., first filed the suit in 2015. The US Department of Justice joined the suit in 2019. Both parties accused Omnicare of improperly billing Medicare, Medicaid, and Tricare prescriptions for patients in assisted-living communities, group homes, and other long-term care facilities without valid prescriptions. Advertisement CVS plans to appeal. 'This lawsuit centered on a highly technical prescription dispensing record keeping issue that was allowed by law in many states,' said Ethan Slavin, a spokesman for CVS, in a statement to the Globe on Thursday. 'The dispensing practices referenced were limited to Omnicare, ended in 2018, were used by many others in the industry at the time.' Slavin said the practices were accepted by the federal Centers for Medicare & Medicaid Services. Advertisement Slavin said there was no claim in the case that 'any patient paid for a medication they shouldn't have or that any patient was harmed.' A jury 'False claims in the healthcare industry cost every American,' said US Attorney Jay Clayton The False Claims Act allows whistleblowers to bring complaints on the federal government's behalf. The law is key for the government to combat fraud. The law requires tripling of damages, which inflated CVS' penalty. But the company argues the award violates the Constitution's barring of excessive fines. 'The decision on penalties is unconstitutional, especially given the fact that there is no evidence that a single patient suffered harm,' said Slavin. 'We plan to appeal once the judgment is entered.' In 2024, CVS Health reported McMahon wrote in her order that while the fine 'is a very big number,' this 'was a very big fraud on the government, one that lasted over almost a decade, and that Omnicare was aware of but avoided taking steps to correct.' Alexa Gagosz can be reached at
Reuters
08-07-2025
- Health
- Reuters
Judge orders CVS' Omnicare unit to pay $949 million over invalid prescriptions
NEW YORK, July 8 (Reuters) - A federal judge ordered CVS Health's (CVS.N), opens new tab Omnicare unit to pay $948.8 million in penalties and damages, in a whistleblower lawsuit claiming it fraudulently billed the U.S. government for invalid drug prescriptions. In a Monday evening order, U.S. District Judge Colleen McMahon in Manhattan imposed a $542-million penalty for filing 3,342,032 false claims between 2010 and 2018. McMahon also awarded $406.8 million of damages, representing three times the $135.6 million that a jury awarded on April 29. The tripling was required under the federal False Claims Act, which lets whistleblowers sue on behalf of the federal government and share in recoveries. CVS plans to appeal the judgment. The Woonsocket, Rhode Island-based drugstore chain and pharmacy benefits manager bought Omnicare in 2015. Omnicare has asked McMahon to throw out the case or grant a new trial. "This lawsuit centered on a highly technical prescription dispensing recordkeeping issue that was allowed by law in many states," CVS said in a statement on Tuesday. "There was no claim in this case that any patient paid for a medication they shouldn't have or that any patient was harmed." The lawsuit was filed in 2015 by Uri Bassan, a former Omnicare pharmacist in Albuquerque, New Mexico, and joined by the federal government in 2019. They said Omnicare improperly billed Medicare, Medicaid, and Tricare, which serves military personnel, for prescriptions for tens of thousands of patients in assisted-living facilities, group homes for people with special needs, and other long-term care facilities. Omnicare allegedly assigned new prescription numbers without necessary paperwork and pharmacist approvals, after the original prescriptions expired or ran out of refills. McMahon rejected CVS' argument that a $948.8-million award violated the U.S. Constitution's prohibition against excessive fines under the Eighth Amendment. "This was a very big fraud on the government, one that lasted over almost a decade, and one that Omnicare was aware of but avoided taking steps to correct," the judge wrote. McMahon found CVS jointly liable with Omnicare for $164.8 million of the penalties, after jurors found it failed to stop Omnicare from submitting 30% of the false claims after buying that company. CVS itself did not submit any claims. The case is U.S. ex rel Bassan v. Omnicare Inc, U.S. District Court, Southern District of New York, No. 15-04179.
Yahoo
06-07-2025
- Health
- Yahoo
You answered one Tricare question and now you're the expert
Tricare is one of those systems you either kind of understand or absolutely don't. There's no in-between. And if you're one of the unicorn spouses who somehow managed to figure it out? If you've navigated MilConnect without rage-quitting, chosen the right plan, locked in a PCM who isn't deployed, and convinced a provider to actually accept Tricare rates? You're it now. You're the reference point. The urgent care whisperer. The unofficial customer service rep for your entire spouse group. It usually starts small. You answer one question in the group chat correctly. Or you mention something helpful at a Unit Family Day. Next thing you know, someone's texting you at 8:42 p.m. to ask whether urgent care visits count toward the deductible under Tricare Select, and you're explaining how referrals work with all the clarity of someone who never meant to memorize the rules but accidentally did. You didn't sign up for this job. But now everyone thinks you work there. It took you three PCS moves, one misrouted prescription, and two near-screaming matches with an off-base pediatric clinic to finally understand how Tricare actually works. And now you do. On more than one occasion, you've explained the following: Your coverage lives and dies with DEERS. If it's not up to date, nothing else works. If your info isn't correct in the Defense Enrollment Eligibility Reporting System, your kid doesn't show up in the system and you're paying out-of-pocket at the pharmacy until it's fixed. You update DEERS on MilConnect now like it's a ritual, every move, every baby, every new assignment. The plans aren't one-size-fits-all, and no one explains that clearly. You know that Tricare Prime is free but requires referrals for anything more complicated than a sinus infection. You know that if you're not near a military treatment facility, Select will give you more control but comes with out-of-pocket costs. You've explained the difference at least a dozen times to new spouses who thought 'Select' meant 'better.' Guard/Reserve coverage doesn't just happen. You've watched families assume they were covered under Tricare Reserve Select, only to find out (during an emergency, of course) that enrollment requires paperwork and premiums. No one told them. You tell them. Tricare for Life is a gift but only if you enroll in Medicare Part B on time. You've walked one too many retirees through the panic of almost missing that deadline. Your knowledge base for Tricare extends beyond just booking routine appointments. Now you know that: Express Scripts delivers prescriptions straight to your door for free, and anyone standing in line at the pharmacy on base might be doing it the hard way (unless it's antibiotics—then you know you're back in line with the rest of us). The Nurse Advice Line is your secret weapon when it's 10 p.m., your kid has a fever, and you don't know whether you need urgent care, ER, or just Tylenol and a popsicle. It's open 24/7. Most people don't even know it exists. Referrals must go through your PCM, and calling a specialist directly—no matter how well-meaning—is a great way to get hit with an unpaid bill. You've now said, 'Wait, did you get a referral for that?' more times than you can count. Not all providers who take Tricare accept Tricare rates. That's a hard lesson. And you've learned to check the Tricare Provider Directory every time before scheduling anything outside the MTF. You've learned the hard way that understanding your plan is the only thing that stands between smooth care and complete chaos. When you're the one who knows the system, it's easy to become the person everyone turns to. And for a while, that feels good. But eventually, it catches up with you. You find yourself answering questions in the school pickup line, in the commissary aisle, in the middle of your own dental cleaning. Being generous with your knowledge doesn't mean making yourself available at all times. You're allowed to redirect and to say, 'I'm not sure, but you can find that on the Tricare site.' We Are The Mighty is a celebration of military service, with a mission to entertain, inform, and inspire those who serve and those who support them. We are made by and for current service members, veterans, spouses, family members, and civilians who want to be part of this community. Keep up with the best in military culture and entertainment: subscribe to the We Are The Mighty newsletter. These hacks are 'totes' the smart way to PCS 4 secret skills milspouses have but don't realize 4 milspouse personas you'll meet during deployment
India Today
13-06-2025
- Health
- India Today
Indian-American physician gets 10-year jail term for healthcare fraud
A 52-year-old Indian-American physician from Chicago, Mona Ghosh, was sentenced to a 10-year jail term for medical fraud. She submitted reimbursement claims for services and procedures that were either not provided or not medically necessary. Prosecutors said the fraud endangered patients' health and 2018 and 2022, she submitted fraudulent claims to federal programmes such as Medicaid and Tricare, as well as to private insurers, and also directed her employees to do the also said some procedures were performed without patient consent, according to a statement issued by the US Attorney's Office, Northern District of Illinois. Mona Ghosh owned and operated Progressive Women's Healthcare, which specialises in obstetrics and gynaecology fraudulent claims included endometrial ablations and biopsies, ultrasounds, vaccinations, laboratory blood tests, and tests for sexually transmitted used wrong billing codes, a standardised system used to identify and report the services and procedures provided by healthcare professionals in the US, to make the visits seem more serious than they really were, so she could get more money than she was supposed to."Ghosh also fraudulently overstated the length and complexity of in-office and telemedicine visits and submitted claims using billing codes for which the visits did not qualify in order to seek higher reimbursement rates. Ghosh prepared false patient medical records to support the fraudulent reimbursement claims", the statement who belongs to Inverness in Illinois, on June 27 last year pleaded guilty to two counts of healthcare fraud. On June 9, US District Judge Franklin U Valderrama imposed the ten-year prison sentence and ordered Ghosh to pay approximately $1.5 million (approximately Rs 12.5 crore) in GHOSH'S FRAUD ENDANGERED PATIENTS' HEALTH: US ATTORNEY"When physicians submit fraudulent claims to federal health care programs, they divert taxpayer-funded resources away from those who truly need them," said US Attorney Boutros."Dr Ghosh's fraud scheme was particularly egregious because she endangered the health of her patients by performing unnecessary medical procedures, including procedures that severely limited some patients' ability to have children in the future (sic)," Boutros attorney also applauded the victims' strength to come forward and confront this defendant."Dr Ghosh spent years traumatising patients, lying to insurers, and stealing taxpayer money to feed her greed (sic)," said FBI SAC this month, a US-based, Indian-origin pharma tycoon was arrested at Los Angeles International Airport over his alleged involvement in a $149-million healthcare fraud. Tonmoy Sharma, 61, originally from Guwahati, Assam, is the founder and former CEO of Sovereign Health Group, a company that provides addiction treatment services.
