Massachusetts AG settles with Target over Medicaid fraud allegations

by Ben Vernia | December 13th, 2018

On December 11, the Massachusetts Attorney General announced that Target Corp., which provides pharmacy services, had agreed to pay the commonwealth $3 million to settle allegations that it submitted false claims to Massachusetts’ Medicaid program by refilling prescriptions automatically. According to the AG’s press release:

Target Corp. has agreed to pay $3 million to resolve allegations that it violated federal and state law by improperly billing and receiving payments from the state’s Medicaid program (MassHealth), Attorney General Maura Healey announced today.

Under the terms of the settlement, Target Corp. will pay $3 million to resolve allegations that from August 2009 through July 2015, the company operated an unauthorized automatic refill program at their Massachusetts locations.

Current regulations prohibit pharmacies in Massachusetts from automatically refilling prescriptions that were not explicitly requested by a MassHealth patient or caregiver at the time of each filling event. The AG’s Office alleges that Target automatically refilled prescriptions and billed MassHealth inappropriately for them

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The AG’s Office has previously taken action against pharmacies for using improper automatic refill programs for MassHealth members. In August, PharmaHealth agreed to pay $360,000 to settle allegations of operating an unauthorized automatic refill program. In 2015, Neighborhood Diabetes paid $1.5 million to resolve allegations of improper billing and in 2013, AllCare Pharmacy paid $1.6 million to settle with the AG’s Office to resolve similar allegations.

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The case arose from a whistleblower’s suit filed in federal court in Minnesota (the Minnesota United States Attorney’s Office also issued a press release). Neither the Government nor the Commonwealth disclosed the amount of the whistleblower’s share of the settlement.

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