Supplier Sues Pharmacy After Failed Reimbursement

On Thursday a case was filed in the Western District of Oklahoma by Pharmacy Providers of Oklahoma (PPOK) against Best Care Pharmacy. The case is regarding breach of contract regarding a reimbursement provision in a contract.

PPOK, according to its complaint, is a pharmacy claim payment intermediary between the defendants and insurance companies such as Caremark. As a part of this arrangement, the plaintiff collects payments from insurance companies and retransmits them to the pharmacy they pertain to in a simplified payment format.

However, payments from insurance companies are subject to recoupment as claims are reprocessed by insurance companies due to errors or other bill payment reasons. The contract between PPOK and the defendants included a clause stating that if the payment was recouped from PPOK by an insurance company, that the defendants would reimburse PPOK for that amount.

Caremark audited the defendants claims and alleged that the defendants failed to collect copayments, resulting in a recoupment of over $530k, which was taken from the plaintiff. The defendant has appealed the recoupment, but has been unsuccessful in overturning the decision. The defendant has also failed to abide by the reimbursement provisions of the contract with PPOK.

Plaintiff is suing for breach of contract and seeks an injunction to prevent the defendants from moving capital from the defendants accounts to other pharmacies accounts. Plaintiff is represented by Conner & Winters LLP.