Walgreens settles Medicaid billing allegations

Pharmacy chain store giant Walgreens has agreed to pay the U.S. and four additional states, $9.9 million to resolve allegations that it falsely billed the Medicaid program. According to the allegations, Walgreen's submitted claims to Medicaid agencies in four states for prescriptions dispensed to persons with both Medicaid and private third-party insurance. Walgreens allegedly turned around and charged the four state Medicaid programs the difference between what privacy insurers paid and what the programs would have paid without private insurers.

The feds decided that this was a false billing situation, concluding that Walgreens was only entitled to what it would have gotten if the claims were submitted to the private insurer, probably a co-pay amount. Since Walgreens submitted claims to Medicaid that exceeded co-pay amounts, they were out of line, officials said.

To learn more about the case:
- read this HealthcareFinanceNews article [1]

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HHS: Medicare pharmacy pay lower than Medicaid [3]