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Pharmacy settles fraud claim over unverified ADD prescriptions

A national pharmacy chain that operates locations throughout Wisconsin has settled a whistleblower lawsuit that alleged the company filled prescriptions without verifying their medical necessity. Medicaid rules require pharmacies to verify medical necessity for certain stimulant medications before seeking reimbursement from the Medicaid program. The rules serve a gatekeeping role to ensure that taxpayer money that is used to purchase prescription drugs only pay for medications that are medically necessary, according to Matthew D. Krueger, United States Attorney for the Eastern District of Wisconsin.

In the recent lawsuit, workers noted that the pharmacy chain allegedly was not verifying medical necessity for stimulant prescriptions, such as those that are designed to treat such as attention deficient disorder, before seeking funds from Medicaid to pay for the medications.

In sidestepping the verification regulations, the effect of the flawed process resulted in Walgreens billing the Wisconsin Medicaid program for prescriptions that were medically unnecessary, according to the lawsuit. The pharmacy chain settled the lawsuit, without admitting any liability. The company has agreed to pay $3.5 Million to settle the claim in Wisconsin. The allegations are part of a multi-state claim. The recent announcement in Wisconsin does not address allegations in any other state.

Individuals May File Federal Claims On Behalf Of Taxpayers

The False Claims Act allows individuals in the private sector -- typically workers at companies that do business with the federal government or obtain revenues through federal programs – to bring forth claims of fraud when there is evidence that taxpayer money is being unlawfully obtained. Individuals work with lawyers who are experienced in federal whistleblower claims to file lawsuit on behalf of the government. The Department of Justice may intervene in the lawsuits. Whistleblowers are entitled to receive a portion of the proceeds of any verdict or settlement for their efforts in protecting taxpayer money.

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