Kentucky joins DOJ, multi-state coalition in $75m settlement with Bristol-Myers Squibb for overcharging Medicaid
Under the settlement, the pharmaceutical manufacturer has agreed to pay $75 Million to resolve these allegations.
The Kentucky Medicaid Program will receive $1,274,861.61 in restitution and other recovery.
“Medicaid fraud harms Kentucky Medicaid beneficiaries and taxpayers,” said Attorney General Cameron.
“In this case, we partnered with the DOJ and other state Medicaid Programs to investigate allegations of fraud and to stop Bristol-Myers from defrauding Kentucky’s Medicaid Program. We are pleased that our efforts returned over $1.2 million to Kentucky’s Medicaid Program.”
This settlement resolves allegations that Bristol-Myers Squibb underpaid drug rebates owed to the states. Under the Medicaid Drug Rebate Program, drug manufacturers must periodically return a portion of the amount paid by state Medicaid programs for the manufacturers’ drugs.
The rebate program is designed to ensure that states pay competitive prices for drugs, and the rebates for a manufacturer’s drugs are calculated based on a percentage of the average prices drug wholesalers pay for each of the drugs. This average price, which the manufacturer reports to the federal government, is known as the Average Manufacturer’s Price or “AMP.”
The coalition’s investigation into Bristol-Myers stems from a whistleblower lawsuit filed in Pennsylvania against the New York- based pharmaceutical manufacturer. The whistleblower’s complaint alleged that Bristol-Myers Squibb improperly treated certain fees paid to wholesalers as “discounts.”
The suit also claimed that Bristol-Myers failed to include certain “price appreciation” amounts it received from wholesalers in its AMP calculations.
These actions falsely decreased the AMP the companies reported to the federal government and improperly reduced the rebates paid to the states.
A National Association of Medicaid Fraud Control Units (NAMFCU) team participated in the investigation and conducted the settlement negotiations with Bristol-Myers Squibb on behalf of the states. ■