The Massachusetts Attorney General's Office has finalized settlements with two independent pharmacies, Granby Pharmacy and Galaxy Pharmacy, over allegations of false claims submitted to MassHealth. The agreements require Center Pharmacy to pay over $230,000 and Galaxy Pharmacy more than $270,000, totaling over $500,000 in restitution.
Both pharmacies will also establish a three-year compliance monitoring program at their own expense. This initiative includes updated policies and procedures to ensure adherence to MassHealth requirements, staff training on these updates, and annual audits.
The Attorney General's Office alleges that between August 2023 and October 2023, Center Pharmacy submitted numerous false claims for the prescription vitamin Profola. The pharmacy reportedly misrepresented patient requests for Profola prescriptions to physicians. During this period, Center Pharmacy filed 72 claims for 51 individuals, resulting in reimbursements exceeding $116,000 from MassHealth.
Galaxy Pharmacy is accused of submitting unlawful claims since 2018 by automatically refilling prescriptions without explicit requests from MassHealth members or their caregivers. This conduct allegedly contravenes state law.
Assistant Attorney General Mary-Ellen Kennedy and her team handled the case against Center Pharmacy with support from MassHealth. Assistant Attorneys General Natalie Rutkowski and Patrick C. McCooe led the investigation into Galaxy Pharmacy alongside Investigations Supervisors Christopher Cecchini and Shelby Stephens.
These actions are part of ongoing efforts by the Attorney General's Office to address misuse within the MassHealth program. Previous cases include an $800,000 settlement with Bravo Pharmacy in November 2021 for similar violations involving automatic refills.
The Medicaid Fraud Division is certified annually by the U.S. Department of Health and Human Services to investigate health care providers defrauding MassHealth. It also addresses abuse or neglect complaints concerning Medicaid patients in various health care settings.
Funding for the division comes predominantly from a federal grant amounting to $5,922,320 for fiscal year 2025 from the U.S. Department of Health and Human Services. The Commonwealth of Massachusetts provides additional funding totaling $1,974,102 for FY 2025.