Conn. AG, Walgreens reach $140K agreement

Bryan Cohen Jul. 27, 2011, 2:31pm


HARTFORD, Conn. (Legal Newsline) - Connecticut Attorney General George Jepsen and U.S. Attorney David Fein announced a civil settlement on Thursday with a national retail pharmacy chain.

The Walgreen Co. has entered into a civil settlement and will pay $140,000 to resolve allegations that it violated common law and the False Claims Act.

Jepsen and Fein allege that Walgreens fraudulently billed Medicaid and the Connecticut ConnPACE Program for prescription drugs by submitting duplicate or multiple claims to Medicare and Medicaid or ConnPACE for some or all of the prescription drugs provided to individuals who were dually eligible for Medicare Part D as the primary payor, and Medicaid or ConnPACE as the secondary payor.

"Health care providers such as Walgreens must be especially vigilant about billing taxpayer-funded programs accurately for goods and services for the elderly, the disabled, and the needy," Jepsen said. "'Double billing' the federal and state government for medications is simply unacceptable."

Billing errors were detected by the pharmacy unit at the Department of Social Services. A quality assurance audit process then confirmed the errors.

A claim that is "dually eligible" refers to a prescription that must be billed to more than one insurance company - a payor with primary responsibility for the claim and a payor with secondary responsibility to pay the amount the primary payor did not pay. Individuals who were "dually eligible" had access to Medicare Part D as the primary payor of their prescription claims, and either the Connecticut ConPACE program of the Connecticut Medicaid program as the secondary payor of their prescription claims.

Medicare Part D was typically responsible for 80 percent of the cost of the drug, unless it did not cover the cost of the drug. ConnPACE or Medicaid would pay for the remaining 20 percent, or the "co-pay," unless the drug was not covered by Medicare Part D, in which case the state program would pay the full cost of the drug if covered under the state programs. The government alleges that Walgreens charged the full cost of prescription drugs both to the primary payor and to the secondary payor.

Walgreens, to resolve its liability under the False Claims Act, paid $140,000 in order to reimburse the ConnPACE and Medicaid programs for conduct occurring between June 1, 2006 through and including August 31, 2008.

In entering into the civil settlement agreement, Walgreens did not admit liability.

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