Part D Settlement Nets U.S. $5.25M

A sponsor of a Medicare prescription-drug plan has agreed to pay the U.S. government $5.25 million to settle claims that it gave the government false information about drug pricing to lure consumers into signing up for its plan.

The settlement, announced this week in New York, is among the first involving claims brought under the False Claims Act for alleged fraud in the Medicare Part D program.

In the underlying case, the government contended that plan sponsor RxAmerica L.L.C. gave the government one list of prices for use in an online tool where participants could compare plans. But when the participants actually signed up with RxAmerica, the government alleged, the company charged them higher prices.  This, the government asserted, pushed beneficiaries more quickly into the so-called “donut hole” and “catastrophic coverage” phases of Part D coverage, causing a loss to both the beneficiaries and Medicare.

RxAmerica admitted no wrongdoing.

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