PITTSBURGH UPMC won't get overpayments back

UPMC overpaid pharmacists close to $4 million.
PITTSBURGH (AP) -- Dozens of independent pharmacists throughout western Pennsylvania won't have to return alleged overpayments from a UPMC health plan, a judge ruled.
UPMC had maintained that about 320 independent pharmacists were overpaid for nearly a year after UPMC Health Plan/Best Health Care switched to a different company to manage one of its prescription benefits programs. The mistake cost nearly $4 million, according to UPMC.
Pharmacists at about 100 pharmacies joined in a suit to prevent UPMC from cutting future reimbursements to make up for the mistake. This week Allegheny County Judge Judith L.A. Friedman said UPMC couldn't do that.
"Once [UPMC] agreed to pay a pharmacist a certain dollar amount for a particular person's particular prescription, there was no later review of price provided by the contract. As soon as the prescription was filled at the price [UPMC] approved, [UPMC] owed the pharmacist that amount," Friedman wrote in memo accompanying the order.
In a statement released Thursday, UPMC said it would appeal the ruling and that plan members were not affected by the dispute.
"As a responsible company, UPMC Health Plan would not be serving its members, employer group and government payers and health care providers if it did not recover money it still believes was paid in error," the statement said.
A UPMC spokesman declined further comment.
Little guys win
Gerard O'Hare, who owns Jeffreys Drug Store in Canonsburg, Washington County, and is a partner in another pharmacy, was pleased with the ruling.
"Fortunately, the little guy won for a change," he said.
A misunderstanding between UPMC and the company led to the implementation of computer programming command that reimbursed the pharmacists for dispensing generic drugs at the higher rates for brand-name drugs, UPMC contended.
But at a hearing in September, several pharmacists testified that they didn't notice any increase in their reimbursements and didn't notice any change in reimbursements after UPMC corrected the problem last summer.
"[UPMC] determined the price and a year later, they tell us that money was too high," O'Hare said. UPMC wanted about $100,000 returned from his two stores.
"We had plaintiffs that had as little as $5,000 involved, but it was principle of the thing," O'Hare said.