If the history of the Allegiant Experts Blog has proven anything, it’s that there’s a lot of ways to pull off health care fraud. Some doctors submit claims to Medicaid for medical services they never performed. Other physicians concoct schemes to get as many patients as possible so that they can submit false claims and cash out on the back end. And then there are those who auto-fill prescriptions in order to be compensated illegally.

You may be surprised to learn that some of the nation’s biggest retailers have recently agreed to pay nearly $1 million to resolve allegations that they have been involved in a health care fraud scandal. According to the District of Minnesota branch of the United States Department of Justice, both Walmart and Sam’s Club have been found to be in violation of the False Claims Act and Minnesota False Claims Act.

A total of $825,000 has been levied against the companies.

According to the report, which was released on Tuesday, pharmacies for the affiliated companies were submitting claims for automatically refilled prescriptions to Minnesota’s Medicaid program. The state of Minnesota is one of at least 20 states that do not allow pharmacies to automatically refill prescriptions that are paid for the state’s Medicaid program. Medical Assistance is the name of Minnesota’s Medicaid program.

“This policy provides an important control against wasted or unnecessary prescriptions that are reimbursed by taxpayer funds,” explains the report. It goes on to note that Walmart and Sam’s Club pharmacies were alleged to have routinely enrolled Medical Assistance beneficiaries in their respective auto-refill programs. They would then bill Medical Assistance for these prescriptions, putting themselves in direct violation of state rules and regulations.

Complaints made by staff were ignored.

The report also notes that pharmacy employees for both brands reported the violations to company managers. However, they went unheeded. The team of Walmart and Sam’s Club continued to automatically refill Medical Assistance prescriptions. The $825,000 penalty levied against the companies, both named in honour of founder, Sam Walton, will be paid out in two halves: $412,500 to the federal government and $412,500 to the State of Minnesota

United States Attorney Greg Brooker is one of two lawyers who made the announcement earlier this week. “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,” he is quoted as saying in the report.

Minnesota Attorney General Lori Swanson assisted Brooker in making the announcement. “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,” she said.

Are you an attorney trying a health care fraud case?

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