When people in Ohio get injured at work, they have to apply for workers compensation benefits. Part of these benefits include reimbursement for any medical care and prescriptions. The Bureau of Workers Compensation uses a company called OptumRx to fill their workers comp prescriptions in Ohio.
The agreement between the Ohio Workers Compensation Board and OptumRx states that the pharmacy will charge the lowest available prices for any prescriptions filled. When someone in Ohio is out on workers compensation, they’re required to comply with their doctor’s treatment recommendations. If their doctor tells them to take a certain medication, they need to take it. They would order these medications through OptumRx.
OptumRx has a department called Pharmacy Benefits Management Solutions. They are responsible for ensuring that the correct prices are being charged for workers comp claims and prescriptions. When the Ohio Bureau of Workers Compensation realized they were being overcharged, they filed suit against OptumRx and PBM.
The lawsuit alleges that the pharmacy overcharged the Workers Comp Bureau on more than 1.3 million different prescription claims for reimbursement. The total amount of the overpricing was close to $16 million. The report did not indicate if the lawsuit was for this amount or a greater amount.
This past week, the Ohio Bureau of Workers Compensation was able to prove that there were emails internally at OptumRx and PBM showing they knew about the overcharging. This may be enough to make the case settle a lot faster than anticipated. Trial is schedule for the latter part of 2021.
If you’ve been injured at work and are currently receiving workers comp prescriptions in Ohio through the Bureau of Workers Compensation, be careful. If you feel you have been taken advantage of or have not received the benefits you deserve, contact an Ohio workers’ compensation lawyer right away.