Government Wins Medicaid Fraud Case against Walgreens      

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Walgreens Drug Stores agreed today to pay $35 million to the federal government for fraudulent activities regarding three prescription drugs.  What was at the heart of the case was that Walgreen was switching out the prescribed drugs for more expensive brands and by switching these, they substantially increased the amount of money that Medicaid reimbursed them, thus substantially increasing their profits.

Medicaid recipients were unaware of this, and there has been no disclosure in the suit that any recipients were harmed, however, switching medication is not harmless.  Just because it seems so far that nobody was hurt or killed in this situation, there are severe penalties for these practices because serious risks do exists.  Plus, switching medications for profit is simply put, illegal.

Switching medications in this way is a violation of state and federal regulations that are designed to protect patients.  In addition, pharmacies subject themselves to triple damages, civil penalties and attorneys’ fees.  Usually, this, plus the willingness of insiders to report such fraudulent activities helps keep pharmacies in line with regulations, however, this case against Walgreens should be a warning that the government will pursue fraud aggressively.

For Medicaid recipients, it is important that you know that this what Walgreens did in this case is not the same as the pharmacy calling your doctor and asking if the medications could be switched.   That is a practice that pharmacies use if they are trying to correctly fill a prescription with a substitute generic medication.  In the Walgreens case, thousands of prescriptions were replaced without notifying anyone, and that is totally against regulations.

This case should let you know that if you receive Medicaid benefits, there are agencies looking out for your welfare and trying to protect you, and reassure you that most pharmacies try to help their clients by filling the right prescriptions and doing the right thing.

Entry Filed under: General-Medicare