The Department of Justice U.S. Attorney’s Office Southern District of New York (Manhattan U.S. Attorney) announced on January 22, 2019 that the United States filed and settled two healthcare fraud lawsuits against national pharmacy chain Walgreens Boots Alliance, Inc. (“Walgreens”) in which Walgreens must pay the United States and state governments a total of $269.2 million.
First Settlement – Insulin Pens
The U.S. alleged that Walgreens routinely submitted false days-of-supply data to federal healthcare programs when it sought federal reimbursement for insulin pens it dispensed to federal beneficiaries who did not need them. The U.S. alleged that Walgreens engaged in two practices that resulted in the fraudulent submissions: Walgreens configured its electronic pharmacy management system to prevent its pharmacists from dispensing less than a full box of five insulin pens, even when patients did not need that much insulin; and when a full box of insulin pens exceeded the federal healthcare program’s limit on the total days of supply (i.e., the total number of daily doses) that could be dispensed and reimbursed at that time, Walgreens allegedly evaded this restriction by falsely stating in its reimbursement claims that the total days of supply did not go over the limit. The U.S. contended that as a result, federal healthcare programs paid Walgreens millions of dollars for insulin that many beneficiaries did not actually need, and substantial quantities of valuable medication were wasted. The U.S. alleged that this conduct also opened the door to potential healthcare risks and abuse, such as the improper resale of insulin pens on the Internet.
The settlement requires Walgreens to pay approximately $168 million to the U.S., and Walgreens agreed separately to pay approximately $41.2 million to state governments. The settlement was approved on January 16, 2019 by a federal judge and was unsealed on January 22, 2019.
Second Settlement – Discount Drug Pricing
The U.S. alleged that Walgreens operated a program called the Prescription Savings Club (“PSC”) under which customers received discounts when they ordered drugs from Walgreens. Medicaid regulations required Walgreens to seek Medicaid reimbursement only at the lowest of certain drug price points, including the “usual and customary price” (“U&C price”). Medicaid rules of many states defined the U&C price as the price offered through discount programs like the PSC. Contrary to these requirements, Walgreens allegedly did not disclose to Medicaid the discount drug prices it offered customers through the PSC when it sought reimbursement from Medicaid. As a result, Medicaid programs paid Walgreens more in reimbursements than it would have paid had Walgreens disclosed the lower PSC prices.
The settlement requires Walgreens to pay a total of $60 million, of which approximately $32 million is to the United States and approximately $28 million will go to state governments. The second settlement was approved on January 15, 2019 by a federal judge and was also unsealed on January 22, 2019.
In both settlements, Walgreens admitted and accepted responsibility for conduct the U.S. alleged in its complaints under the False Claims Act. Both cases arose from lawsuits filed by whistleblowers under the False Claims Act.
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
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