This suit is about a year and a half old, but it continues a trend that has been in CVS as well, specifically pharmacies bending the rules to get Medicare and Medicaid claims paid. Seeing how thoroughly they audit the pharmacy on a regular basis, it’s amazing to me that this kind of stuff is still going on. Perhaps it’s worth the ultimate settlement amount to risk getting caught because they need the business, but it’s disturbing to hear this pharmacist say they were “routinely” doing this.
SACRAMENTO (CN) – Walgreens defrauded Uncle Sam and California by submitting claims for prescriptions not covered by Medicare or MediCal, a pharmacist claims in a False Claims Act whistleblower complaint.
Glenn Dabek, who worked for Walgreen from 2008-2013, claims he saw pharmacists at more than 12 Sacramento-area pharmacies override Medicare and MediCal payment rejections and fill prescriptions for customers, then use a generic code to justify the Medicare override.
He claims Walgreens falsely represented the prescriptions were covered by Medicare or MediCal in order to “get false or fraudulent claims paid by the U.S. government.”
Dabek sued Walgreen in Federal Court on Nov. 19, 2013 on behalf of California. The case was unsealed Thursday.
Walgreens settled a similar lawsuit for $7.9 million in 2012, after two pharmacists sued it on behalf of the government. Walgreen did not admit wrongdoing or liability in that case. It was accused of luring Medicare and Medicaid patients with gift cards and causing the federal and state governments to pay false claims .
A Walgreens received another blow in December when U.S. Court Judge Anthony Ishii ruled Walgreens owed a full jury award of $1.15 million in punitive damages to a former employee who was fired after he complained about Medicare billing fraud .
“The decision makers intentionally terminated Mitri because Mitri was complaining about billing fraud, utilized a false reason for the termination, relied on a dubious final warning, lied to Mitri that he was being investigated, and did not let Mitri defend himself in any way. Neither the termination nor the events leading up to and surrounding the termination were accidental,” Ishii wrote. Dabek seeks civil penalties and treble damages for False Claims Act violations.