Union Co. pharmacy accused of billing for medications never dispensed settles claims

The allegations arose after two former employees of the pharmacy filed claims under the False Claims Act
(CNN)
Published: Apr. 7, 2023 at 3:07 PM EDT
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CHARLOTTE, N.C. (WBTV) - The Department of Justice and a North Carolina pharmacy, MedCare Clinic & Pharmacy have agreed to a settlement of $213,677 after allegations that the pharmacy violated the False Claims Act, billing federal healthcare programs for medications that were never dispensed.

“The United States alleged that, from Jan. 1, 2016 through Dec. 31, 2019, MedCare billed both Medicare Part D and North Carolina Medicaid for two hundred prescription medications that MedCare never distributed to beneficiaries. According to the government’s allegations, inventory records showed that MedCare did not buy enough of these medications to fill all of the prescriptions billed to these health care programs,” according to a press release from the DOJ.

The False Claims Act (FCA) is a federal statute originally enacted during the Civil War to combat defense contractor fraud.

“Pharmacies may bill only for medications that they actually sell,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “Our office will continue to pursue entities that knowingly and unjustly enrich themselves at the taxpayers’ expense.”

Federal and state programs like Medicaid are expensive and it’s ultimately the taxpayer who loses money when violations of the FCA occur.

“When pharmacies bill government programs for prescriptions that are not disbursed to patients, taxpayer dollars are wasted and finite resources are diverted from beneficiaries in need,” said U.S. Attorney Dena J. King for the Western District of North Carolina. “Our office will continue to work with our state and federal partners to investigate and hold accountable those who seek to profit from fraud on federal health care programs.”

Although the federal government prosecutes these cases in this instance the allegations were brought to the government’s attention after two former employees came forward.

“The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by former MedCare employees Brittanie Henry and Zilphia Adcock. Under those provisions, a private party may file an action on behalf of the United States and receive a portion of any recovery,” according to the DOJ. “Henry and Adcock will receive $53,419.43 as their share of the settlement.”

False claims made at the expense of taxpayers is a serious problem and in 2022, the DOJ received $2.2b in settlements for cases involving fraud and false claims.

“The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477),” according to the DOJ.

Because the allegations are settled they remain allegations only and no determination of liability has been made.

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