Fourth Question of the Day July 15, 2014 What types of liability would PBMs face if they continued to reimburse for compounded medications that might be against the law?

PBM and pharmacy fraud resulting in whistleblower rewards include:
Medco Paid U.S. $155 Million to Settle False Claims Act Cases

• The whistleblowers in the case received $23 million for helping the government uncover allegations that Medco:
  • solicited & accepted kickbacks from pharmaceutical manufacturers to favor their drugs; and
  • paid kickbacks to health plans to obtain business.

CVS Caremark Agrees to $36.7 Million Settlement for Overbilling

• The whistleblowers in the case received $4.3 million for helping the government uncover allegations that CVS Caremark illegally substituted a more expensive capsule form of the drug instead of the prescribed tablets to increase its Medicaid reimbursement.

Omnicare to Pay $49.5 Million to U.S. & 43 States to Settle Medicaid Prescription Drug Related Fraud Allegations

• The whistleblowers in the case received $7.2 million for helping the government uncover allegations that Omnicare substituted different versions of prescribed drugs, such as tablets for capsules, solely to significantly increase the cost and profit rather than for any legitimate medical reason.
• quoted from here