Pharmacists have initiated a number of highly successful qui tam actions under the False Claims Act. As the front line professionals responsible for dispensing medications to Medicaid beneficiaries, pharmacists are particularly well suited to discover and report Medicaid fraud. The Walgreens settlement marks another successful result of actions taken by pharmacists to protect taxpayer funds.
The pharmacist became a qui tam relator after discovering the drug switching in processing transfers of prescriptions from Walgreens pharmacies. According to his qui tam Complaint, the pharmacist discovered the Medicaid fraud after noting that a Walgreens prescription was for ranitidine capsules rather than tablets, the industry standard. The pharmacist relator stated that Walgreens pharmacists told him that the pharmacy chain had set up its system to fill all ranitidine prescriptions as capsules regardless of what a physician had specifically prescribed.
The same pharmacist relator also successfully pursued a qui tam action against CVS pharmacies for Medicaid fraud arising from drug switching, which resulted in a $37 million settlement.
The initial qui tam case by the relator pharmacist was against his prior employer, Omnicare Inc., the nation's largest pharmacy for nursing homes. That Medicaid fraud case resulted in a $50 million settlement of False Claims Act allegations.
A pharmacist's report to the government led to a $50 million settlement by Omnicare, Inc., the nation's largest pharmacy for nursing homes, to resolve federal and state charges that it defrauded Medicaid by switching generic drugs. The Omnicare case was the first to challenge generic drug switching, and served to strengthen Medicaid's price containment programs for generic drugs. The relator discovered the conduct which led to this settlement while he was a pharmacist at Omnicare. The pharmacist relator was represented by Behn & Wyetzner, Chartered.