Walgreens Boots Alliance Inc. and Walgreen Co. (together, Walgreens) have agreed to pay $106.8 million to resolve alleged violations of the False Claims Act and state statutes for billing government health care programs for prescriptions never dispensed. Walgreens, headquartered in Deerfield, Illinois, operates one of the largest retail pharmacy chains in the country.
The government alleges that, between 2009 and 2020, Walgreens submitted false claims for payment to Medicare, Medicaid and other federal health care programs for prescriptions that it processed but that were never picked up by beneficiaries. As a result, Walgreens received tens of millions of dollars for prescriptions that it never actually provided to health care beneficiaries.
As part of the resolution, Walgreens received credit under the department’s guidelines for taking disclosure, cooperation and remediation into account in False Claims Act cases. Among other actions, Walgreens implemented enhancements to its electronic pharmacy management system to prevent this from occurring in the future and self-reported certain conduct. Because Walgreens previously refunded $66,314,790 pertaining to the settled claims, Walgreens will receive a credit for this amount.
“Federal health care programs provide critical health care services to millions of Americans,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We will hold accountable those who abuse these programs by knowingly billing for goods or services they did not provide.”
“Millions of Americans rely on the promise of federal healthcare through programs like Medicare and Medicaid,” said U.S. Attorney Alexander M.M. Uballez for the District of New Mexico. “Fraudulently billing for prescriptions which are never dispensed endangers the integrity of these critical programs. We are committed to guarding the public’s investment in our health from private corporations.”
“Adopting new technology and systems can be beneficial for providers, beneficiaries, and federal payors, including Medicare, Medicaid and TRICARE,” said U.S. Attorney Damien M. Diggs for the Eastern District of Texas. “However, we will not allow companies to hide behind their implementation of ill-conceived technology and systems that result in billing federal health care programs for goods and services never provided to beneficiaries. In those situations, we will pursue the companies and ensure that the taxpayer is made whole.”
“This settlement marks another major achievement in our ongoing commitment to combat healthcare fraud,” said U.S. Attorney Roger B. Handberg for the Middle District of Florida. “It is essential to hold pharmacies accountable when they knowingly fail to abide by the rules and requirements of our national health care programs.”
“Medicare enrollees, and consumers at-large, rely on pharmacies for critical medications that sustain their quality of life, and providers who prey upon public health care programs to increase profit margins must be held accountable,” said Deputy Inspector General for Investigations Christian J. Schrank of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS-OIG is unwavering in its commitment to protecting taxpayer-funded healthcare programs and ensuring those that threaten their integrity are held liable for their actions.”
The federal share of the recovery is $91,881,530, and a total of $14,933,259 will be returned to individual states, which jointly fund state Medicaid programs, through separate settlement agreements with the Medicaid participating states.
The federal government’s settlement with Walgreens resolves three cases pending in the District of New Mexico, Eastern District of Texas and Middle District of Florida under the qui tam, or whistleblower, provision of the False Claims Act, which permits private parties to file suit for false claims on behalf of the United States and to share in any recovery. Steven Turck, a former Walgreens pharmacy manager, filed the qui tam suit in the Eastern District of Texas related to billing Medicare, Medicaid and other federal health care programs, and will receive $14,918,675. Andrew Bustos, a former Walgreens district pharmacy supervisor, filed the qui tam suit in the District of New Mexico related to billing Medicare Part B and will receive $1,620,000.
Trial Attorney Seth Greene of the Civil Division’s Commercial Litigation Branch, Fraud Section; Assistant U.S. Attorneys Ruth Keegan and Sean Cunniff and Auditor Julie Chappell for the District of New Mexico; Assistant U.S. Attorneys James Gillingham and Adrian Garcia for the Eastern District of Texas; and Senior Litigation Counsel Lindsay Griffin for the Middle District of Florida handled the matters. HHS-OIG and the National Association of Medicaid Fraud Control Units assisted in the investigations.
The investigation and resolution of these matters illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to HHS at 800-HHS-TIPS (800-447-8477).
The civil settlements with Walgreens resolved the following captioned cases: United States ex rel. Bustos v. Walgreens Boots Alliance, Inc., et al., No. 1:15-cv-781 (DNM); United States ex rel. Turck, et al. v. Walgreens Boots Alliance, Inc., et al., No. 4:19-cv-315 (EDTX); and United States, et al. ex rel. Jacob v. Walgreens Boots Alliance, Inc., No. 8:20-cv-858-T-60TGW (MDFL).
*This release has been updated to remove an allegation that is not in the settlement agreement.
No comments:
Post a Comment