OptumRx
Health care giant confirms $15M settlement — two days after denying it
A prescription middleman on Friday confirmed that it has promised to pay Ohio $15 million to settle fraud claims against it. When the state announced the deal two days earlier, the company denied it had been finalized. Ohio Attorney General Dave Yost on Wednesday announced that pharmacy benefit manager OptumRx had agreed to pay $15 […]
Pharmacy middleman agrees to pay Ohio Workers’ Comp $15M, attorney general says
OptumRx, a huge pharmacy middleman, has agreed to pay the Ohio Bureau of Workers Compensation $15 million to settle claims that it overbilled the system between 2015 and 2018, Attorney General Dave Yost announced Tuesday.
Deep inside the gun bill: a break for drug middlemen
Many Americans across the political spectrum are clamoring for federal action on guns in the wake of a mass shooting at an Uvalde, Texas, elementary school, a Buffalo, N.Y., grocery store and hundreds of other mass shootings. But buried in a bipartisan compromise hashed out by the U.S. Senate on Tuesday is an unrelated provision they might not be so happy about. Apropos of nothing, the gun bill would enhance the exemption drug middlemen working with Medicare have from the federal "Anti-Kickback Statute."
After years, pharmacy-middleman suit might finally come to trial
Since at least 2016, Ohio pharmacists have been accusing large companies acting as pharmacy middlemen of abusive practices, which they deny. And since 2019, the state has been accusing them as well, in the form of lawsuits. Now, after years of wrangling in court, some of that litigation might be headed to trial. The middlemen, […]
Louisiana sues health care company over practices under investigation in Ohio
Louisiana is suing health care giant UnitedHealth over several business practices, saying it is seeking “to recover billions of dollars in inflated prescription-drug prices” for the state Medicaid program. Among its allegations, the state accuses the company of gaming federal oversight reports meant to ensure that at least 85% of the money it gets from […]
Attorney General seeks financial info from Medicaid contractors
In the past month, Ohio Attorney General Dave Yost has sought financial information from the state’s five managed-care contractors, documents received in response to an open-records request show. The AG won’t discuss ongoing investigations, but he might be looking into whether some practices by subcontractors who manage pharmacy benefits violate state law or federal regulations. […]
State employee pension fund to audit big PBM
The upcoming audit will be the fifth time in 10 years that the pharmacy benefit manager to the Ohio Employees Retirement System has been audited. An earlier version of this story said it had been audited more frequently. It’s been updated. The Ohio Employees Retirement System is seeking proposals for a firm to audit Express […]
With big Medicaid changes looming, Ohio pharmacists complain of a lack of details
The Ohio Department of Medicaid plans to radically change the way it does business in July, but a group that helped motivate the reform effort says it hasn't provided some fundamental details. Some members of that group, the state's community pharmacists, say those details could determine whether they can stay in business — and whether some small towns become pharmacy deserts.
Basketball billionaire enters the no-insurance, no-middleman drug business
Mark Cuban, owner of the Dallas Mavericks, is getting into a business pioneered by independent pharmacists in Ohio and elsewhere. The idea is to radically reduce consumer costs for common generic drugs by cutting out insurance companies and the middlemen they hire to handle transactions with manufacturers and pharmacies. On Jan. 19, the Mark Cuban […]
Health companies accused of abuses even as they get giant government contracts
Even though two huge health care companies were accused of abusing Ohio taxpayers in the past, the Ohio Department of Medicaid this year awarded them historic contracts, anyway. Even as that’s happening, another form of abuse might be taking place, critics say. At issue is whether pharmacy middlemen owned by the companies are pocketing huge […]
Insurers slam critical drug-pricing research but can’t vouch for their own
A spokeswoman for a major health-insurance industry group on Wednesday questioned research cited in a story published Tuesday in the Capital Journal. In doing so, she cited a bit of purported research that she couldn’t vouch for herself. The story was about research showing that insurers working with Medicare are supposed to be lowering care […]
Medicaid giant settles with fifth state
Centene, the nation’s largest Medicaid managed-care provider, has settled fraud allegations with a fifth state, Kansas Attorney General Derek Schmidt announced Monday. The $27.6 million Kansas settlement comes after Mississippi, Illinois and Arkansas announced settlements totaling $154 million. All of those follow a settlement with Ohio — the only state to actually sue the company […]