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Retail giant settles Medicare fraud case

| Feb 7, 2019 | Health Care Investigations |

The Office of Inspector General (OIG) for the United States Department of Health and Human Services (HHS) has required pharmacy giant Walgreen’s to partake in a Corporate Integrity Agreement. The agreement requires the retail store and pharmacy to agree to broad oversight and reviews to ensure it is following requirements when involved in federal programs.

This agreement is part of a larger settlement that resulted from two separate allegations of health care fraud.

First allegation: Prescriptions regardless of medical need

The government’s first claim involved allegations the store preset its system to only allow pharmacists to prescribe a full box of insulin shots, regardless of a patient’s medical need.

In addition to providing medication beyond a patient’s medical need, the Medicare program also has a limitation on the number of doses that can be dispensed and reimbursed. This dosage exceeded that limit. However, the government claims that Walgreen’s failed to properly report the dosage in an attempt to circumvent the system and still receive reimbursement.

Walgreen’s agreed to a settlement in this case, including a payment of $168 to the federal government and a payment of over $40 million to impacted state governments.

Second allegation: Overpayment

The complaint also accuses Walgreen’s of failing to disclose a program that allowed the public to receive a discounted price on medications. Although the pharmacy would offer this lower price to Medicaid patients, it charged the government the full price. Walgreen’s agreed to pay $32 million to the United States government to settle this claim and an additional $28 million to impacted states.

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