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Judge Upholds $3.3 Million Judgment In Favor of Fox Insurance Company Against Former Pharmacy Benefit Manager
Date:5/22/2012

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Fox also demonstrated that it had repeatedly asked ProCare to upgrade its software in order to satisfy CMS requirements and instructions regarding prior authorization and protected class drugs.  While ProCare had informed Fox that these upgrades had occurred, they had, in fact, not, which may have threatened Fox's standing with CMS. 

These claim denials drove CMS to take action against Fox in 2010, which resulted in the termination of its contract as a Medicare Part D provider.  Fox maintained that these denied claims, which were the impetus behind CMS's actions, were caused by ProCare's negligence and not any direct actions by Fox itself.  This assertion was the focal point of the arbitration between Fox and ProCare, with the award resulting in findings that ProCare breached the CSA, improperly withheld rebates owed to Fox, and must collect and turn over to Fox sums identified in a Fraud, Waste and Abuse (FWA) audit of the pharmacies in ProCare's pharmacy network.

Contact:
Jules Abraham
JQA Partners, LLC
917-885-7378
jabraham@jqapartners.com 


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SOURCE Fox Insurance Company
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