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Health Care Giant Confirms $15M Settlement — Two Days After Denying It

ABC News

October 31, 2022

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 million to settle a 2019 lawsuit accusing it of overbilling the Ohio Bureau of Workers’ Compensation between 2015 and 2018, in part by not providing contractually guaranteed discounts.

But late that afternoon, a spokesman for the company, Andrew Krejci, denied that was the case, saying, “We continue to dispute his allegations and are honored to have delivered access to more affordable prescription medications for the Ohio Bureau of Workers’ Compensation and Ohio taxpayers.”

Optum is part of UnitedHealth Group, the nation’s fifth-largest company and owner of the largest health insurer. As a pharmacy benefit manager, Optum has great sway over prescription-drug transactions, including deciding which drugs are covered, negotiating non-transparent rebates with drugmakers and determining how much to reimburse the pharmacies that dispense them.

Optum, CVS Caremark and Express Scripts control more than 70% of that marketplace. Critics allege that they use their size and a lack of transparency to inflate their profits and the ultimate cost of drugs.

Read Health Care Giant Confirms $15M Settlement — Two Days After Denying It.