Under federal and state laws, a pharmacy that fills prescriptions for Medicaid beneficiaries may not charge the government more than the drug’s “usual and customary” price. The whistleblower in this case came forward with evidence that Walgreens charged government programs more for prescription drugs than it charged some customers who were enrolled in the company’s Prescription Savings Club (“PSC”).
After the whistleblower filed a qui tam or whistleblower lawsuit “under seal” (that is, in secret), the government conducted an investigation using the evidence he provided. Walgreens ultimately settled the fraud claims by agreeing to pay back $60 million to federal and state Medicaid programs. As part of the settlement, the company admitted that the government “paid Walgreens more money in reimbursements than they would have paid if Walgreens had identified its PSC prices as its [usual and customary] prices.”
It is unlikely that the fraud would have been discovered without help from a whistleblower on the inside. This case demonstrates the power of a single individual to save the government – and taxpayers – tens of millions of dollars by coming forward with evidence of fraudulent claims. It is also another example of the significant rewards that are available to whistleblowers who help the government uncover fraud, waste, and abuse in our healthcare programs.
The whistleblower laws, however, are complicated. This is not something a whistleblower can or should handle on their own. If you have evidence of false claims submitted to Medicare or Medicaid, then you should consult with an attorney immediately to understand and protect your rights.
To schedule a consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728.