Broward County contracted with OptumRx PBM of Wisconsin, LLC (f/k/a Catamaran PBM Services, LLC, as assignee of Catamaran PBM of Illinois II, Inc.) (“OptumRx”), to provide certain pharmacy benefit management services for the County for plan years 2013 through 2015. The County Auditor engaged an independent auditor to conduct a review of the rebates paid to the County by OptumRx for plan years 2013 through 2015, which audit report was last formally discussed by the Board at its January 9, 2018, meeting (Item 20). At that meeting, the Board directed County staff to continue pursuing the matter and report back to the Board periodically.
The County and OptumRx signed a tolling agreement, dated January 4, 2018, that preserved any and all claims the County may have had against OptumRx as of December 8, 2017. The County and OptumRx also executed an interim agreement to permit an independent third-party auditor, RSM US LLP (formerly known as McGladrey, LLP), to verify whether all rebates received by OptumRx or its subsidiaries had been properly paid to the County as required under the County’s contract with OptumRx. That independent review was completed in May 2019, and RSM submitted a summary report of its findings indicating that more than $500,000 in rebate amounts had been received by OptumRx but not paid to the County. OptumRx has since advised that the rebate amounts withheld constituted “reasonable administrative fees” permitted under the contract for its services. Subsequent to RSM’s summary report, OptumRx notified the County that certain information was not disclosed to RSM relating to additional rebate amounts received by OptumRx but not paid to the County, and that RSM will be updating its report to include more than $150,000 in additional rebate amounts received by OptumRx but not paid to the County for the applicable plan years.
The County Attorney’s Office has been working closely with FASD and the County Auditor’s Office on this matter since January 2018. The pending updated RSM summary report may facilitate a resolution with OptumRx regarding the outstanding amounts due for the 2013-2015 plan years, and County staff and this Office will continue to pursue a negotiated resolution, if possible. Any such resolution would require Board approval.
This item, if approved by the Board, would authorize the County Attorney’s Office to file any appropriate claims against OptumRx and its affiliates if a negotiated resolution cannot be timely achieved.
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