United States Attorney Gregory G. Brooker and Minnesota Attorney General Lori Swanson today announced that Wal-Mart Stores, Inc. and Sam’s West, Inc. (d/b/a Sam’s Club) have agreed to pay a total of $825,000 to resolve allegations that they violated the False Claims Act and Minnesota False Claims Act by submitting claims for payment to Minnesota’s Medicaid program in violation of rules prohibiting Medicaid prescriptions from being automatically refilled.
Minnesota’s Medicaid program, called Medical Assistance, is jointly funded by the federal government and State of Minnesota to provide health care to low-income Minnesotans. Along with at least 20 other states, Minnesota does not allow pharmacies to automatically refill prescriptions paid for by Medical Assistance without an explicit request from the beneficiary for each refill. This policy provides an important control against wasted or unnecessary prescriptions that are reimbursed by taxpayer funds.
According to the allegations in the amended complaint, Walmart and Sam’s Club pharmacies routinely enrolled Medical Assistance beneficiaries in the companies’ auto-refill program, and billed Medical Assistance for prescriptions in violation of state rules and regulations. In addition, according to the allegations, pharmacy employees reported the violation to company managers, yet Walmart and Sam’s Club continued to automatically refill Medical Assistance prescriptions.
U.S. Attorney Greg Brooker said, “Businesses that participate in federally and state funded healthcare programs have a responsibility to ensure compliance with the rules, specifically rules that are in place to avoid unused prescription medications and wasted taxpayer funds."
“We are pleased to have worked with our federal partners in the U.S. Attorney’s Office to ensure that providers who participate in this health care safety net program fairly follow the rules," said Minnesota Attorney General Lori Swanson.
Walmart and Sam’s Club will pay $412,500 to the federal government and $412,500 to the State of Minnesota to settle the claims.
In these civil settlements, Walmart and Sam’s Club have denied the allegations of wrongdoing and False Claims Act liability.
This settlement resolves allegations filed in a civil lawsuit originally brought by a whistleblower under the qui tam provisions of the federal False Claims Act and Minnesota False Claims Act, which allow private parties to bring suit on behalf of the government for false claims and to share in any recovery. The government often relies on whistleblowers to bring fraud schemes to light that might otherwise go undetected.
The case was handled by the Civil Division of the U.S. Attorney’s Office for the District of Minnesota and the Medicaid Fraud Control Unit of the Minnesota Attorney General’s Office, with substantial assistance provided by the Office of Inspector General of the U.S. Department of Health and Human Services.
The case is United States of America and the State of Minnesota ex rel. Ryan Mesaros v. Wal-Mart Stores, Inc., and Sam’s West, Inc. (d/b/a/ Sam’s Club), Civil No. 14-CV-3105 (DSD/LIB). The claims resolved by the settlement are allegations only; there has been no determination of liability.
Source: U.S. Department of Justice, Office of the United States Attorneys
