An Aetna actuary who accused CVS Caremark of a massive fraud scheme was placed on administrative leave days after she refused the insurer's request to destroy documents, according to her attorney.
Sarah Behnke, Aetna’s head actuary for Medicare Part D, claimed CVS billed the Centers for Medicare & Medicaid Services (CMS) for drugs at a higher rate than it paid retail pharmacies. That tactic violated federal regulations requiring pharmacy benefit managers to report so-called “pass-through” prices, according to the complaint.
Behnke’s whistleblower lawsuit, which was filed in 2014, was unsealed on April 4. Behnke was placed on paid leave days later, according to her attorney, Susan Schneider Thomas of Berger & Montague.
After the case was unsealed, Thomas said Behnke declined to meet with Aetna attorneys who requested she return and destroy all documents she obtained from Aetna.
In an apparent bid to keep Behnke's claims under wraps, last week, Aetna requested the U.S. District Court for the Eastern District of Pennsylvania allow it to file a motion under seal to intervene in the case against CVS. CVS Caremark is a subsidiary of CVS Health, which is in the process of acquiring Aetna for $69 billion.
“We know what they already asked our client to do,” Thomas said. “What they will ask for from the court, we don’t know yet.”
An Aetna spokesperson declined to comment. CVS has denied the Behnke's allegations.
The complaint alleges the fraudulent claims cost Medicare and patients billions of dollars dating back to 2007. Aetna’s code of conduct (PDF) includes a specific section on whistleblowers who report “suspected or detected misconduct” that violates company policy or federal or state laws.
“Federal laws protect a whistleblower against retaliation,” the policy states. “If any retaliation does occur, whistleblowers have a right to obtain legal counsel to defend their actions.”
The Department of Justice is closely reviewing the CVS-Aetna merger for antitrust concerns. Last week, the Trump administration rolled out a new drug pricing blueprint that emphasized pricing transparency. President Trump specifically vowed to eliminate “middlemen,” an apparent nod to PBMs.
Administration officials have been at events all week speaking about the new attempts to bring down drug prices.
“In light of the administration’s very public comments about trying to control drug prices by increasing PBM transparency, one would think the administration would have a great interest in this case because it’s all about not only a lack of transparency but an outright, we allege, misrepresentation of prices that were required to be reported by one of the biggest PBMs in the country,” Thomas said.