The Fraud Examiner

Case Study in Health Care Fraud: Walgreens Pays $269 Million to Settle Fraud Cases
 

Ron Cresswell, J.D., CFE
Research Specialist, Association of Certified Fraud Examiners                                 


During the 2018 fiscal year, the U.S. Department of Justice (DOJ) recovered more than $2.8 billion from civil cases involving fraud and false claims against the government. Of that $2.8 billion, $2.5 billion (89%) came from health care fraud cases. Last year was the ninth consecutive year in which the DOJ recovered more than $2 billion from health care fraud cases. As those numbers indicate, health care fraud continues to be a massive problem in the U.S.

 

A recent settlement illustrates the scope of the problem. On January 22, 2019, the DOJ announced that it had reached a $269 million settlement with Walgreens in two separate fraud cases. Walgreens is the second largest pharmacy chain in the United States, operating more than 9,000 stores in all 50 states. In the first case, Walgreens was accused of improperly billing government health care programs for insulin pens that patients did not need. In the second case, the government claimed that Walgreens overbilled Medicaid by failing to disclose a discount program.

 

False claims for insulin pens


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