Wal-Mart, Sam’s Club Settle False Claims Allegations
Retail giant accused of submitting claims for payment to Minnesota’s Medicaid program in violation of rules.
Wal-Mart Stores, Inc. and Sam’s West, Inc. (d/b/a/ Sam’s Club) have agreed to pay a total of $825,000 to resolve False Claims violations, according to a May 29 press release from the U.S. Attorney’s Office for the District of Minnesota.
Along with at least 20 other states, Minnesota does not allow pharmacies to automatically refill prescriptions paid for by the state’s Medicaid program, called Medical Assistance, without an explicit request from the beneficiary for each refill.
According to the allegations in the amended complaint, Wal-Mart and Sam’s Club pharmacies routinely enrolled Medical Assistance beneficiaries in the companies’ auto-refill program and billed Medical Assistance for prescriptions in violation of state rules and regulations. Pharmacy employees reported the violation to company managers, according to the allegations, but Wal-Mart and Sam’s Club continued to automatically refill Medical Assistance prescriptions.
Wal-Mart and Sam’s Club will pay $412,500 to the federal government and $412,500 to the State of Minnesota to settle the claims. This settlement resolves allegations filed in a civil lawsuit originally brought by a whistleblower under the qui tam provisions of the federal False Claims Act and Minnesota False Claims Act. Both companies have denied any wrongdoing, and no determination of liability was made.
Such cases affirm the necessity for organizations to establish compliance plans and monitor business practices for noncompliance. The need for Certified Professional Compliance Officers (CPCO™) has never been greater.
The Office of Inspector General (OIG) has developed a series of voluntary compliance program guidance documents directed at various segments of the healthcare industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers, to encourage the development and use of internal controls to monitor adherence to applicable statutes, regulations, and program requirements. Entities can use these guidance documents to develop custom compliance plans that adhere to both local and federal laws.