Walmart settles Medi-Cal Fraud Claims and Agrees to pay $1.65 Million
The U.S. Justice Department announced last month that Walmart has paid $1.65 million to settle claims that it defrauded California’s Medi-Cal program by collecting payments for unneeded or unapproved drugs. Walmart, which has pharmacies in 283 stores in California, was accused of billing Medi-Cal for drugs after misrepresenting doctors’ assessments of the need for the medications. The suit stated that Walmart failed to confirm and document the doctors’ supposed diagnoses in some cases and billed Medi-Cal for drugs that were not prescribed for purposes approved by the program in other cases. Phillip Talbert, the U.S. attorney in Sacramento, stated:
These Medi-Cal regulations are essential to protect both patients and limited health care funding.
According to the lawsuit, which was filed by a former Sacramento-area Walmart pharmacist in 2014 and was later joined by the state of California and federal governments, the pharmacies falsely certified that the patients’ doctors had determined the drugs were appropriate for the patients’ conditions, after assessing their safety, effectiveness, and cost. The former Sacramento-area Walmart pharmacist, Glenn Dabek, will receive $264,000 under a federal whistle-blower law for his efforts to stop the fraudulent activity from continuing. The rest of the settlement goes to the state and federal governments, which fund the Medi-Cal program. The settlement contains no admission of wrongdoing, but at least the fraudulent activity has been stopped.