6 BCBS companies sue CVS, claiming decadelong insurance fraud scheme

Six Blue Cross Blue Shield companies filed a lawsuit against CVS Health, claiming the retail pharmacy chain has "intentionally engaged" in a fraud scheme for more than a decade to overcharge for prescription drugs by submitting insurance claims for payment at artificially inflated prices. 

The plaintiffs include BCBS companies in Alabama, Florida, Minnesota, North Carolina, North Dakota and Missouri. The lawsuit was filed May 27 in a Rhode Island District Court. 

The lawsuit claims CVS offered hundreds of generic drugs at low, discounted prices through cash discount programs. It then used the discount programs to hide the true prices of drugs from third-party payers, according to the lawsuit. 

CVS intentionally told third-party payers that the prices charged to customers for the generic drugs were much higher, and the payers then reimbursed CVS based on the inflated prices instead of the lower prices CVS offered to the general public, the lawsuit claims. 

The BCBS companies said CVS was required by governing contracts to submit the same low price offered to the general public. 

The companies also claim CVS knew it was being overpaid for generic drugs and has pocketed billions from the scheme. They are seeking millions of dollars they say they were overcharged. 

A CVS spokesperson told Becker's Hospital Review the discount programs were intended for customers who either didn't have insurance or chose not to use insurance. None of CVS Pharmacy's discount programs were "in any way concealed, nor fraudulent," the spokesperson said. 

"We did not overcharge plans for prescription drugs, and we will vigorously defend against these baseless allegations, which are completely without merit," the CVS spokesperson told Becker's.

Find the full lawsuit here.

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