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US pharmacy chain settles Medicaid fraud allegations

This article was originally published in Scrip

Executive Summary

The US pharmacy chain Walgreens has paid the US government and four states $9.9 million to resolve allegations it submitted false billings under Medicaid's low-income health programme, the US Justice Department said. The department's civil division alleged that Walgreens submitted claims to Medicaid agencies in the four states for prescription drugs for people covered by both Medicaid and by private third-party insurance. It then allegedly charged the states for the difference between what the private insurers paid and what the state programmes would have paid in the absence of private insurance. The government further alleges that: "The claims were false because the drug chain was entitled to reimbursement from the Medicaid programmes only for the amount the Medicaid beneficiary would have been obligated to pay Walgreens had the claims been submitted solely to the private insurers, typically the co-payment amount, yet it knowingly submitted claims to the Medicaid programmes in excess of the co-pay amount."

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