Walmart pays $1.65 million to settle allegations it wrongfully billed Medi-Cal for certain drugs, DOJ says
Walmart allegedly failed to confirm and document the necessary diagnoses for Code 1 drugs, DOJ said.
Photo courtesy MikeMozartJeepersMedia
Retail giant Walmart has paid $1.65 million to settle allegations it "knowingly submitted" reimbursement claims to California's Medi‑Cal program that did not carry the appropriate diagnosis and documentation, the Department of Justice announced.
Walmart has more than 290 California stores, almost all of which have pharmacies.
[Also: Carolinas Healthcare to pay $6.5 million to settle upcoding allegations related to lab tests]
Medi-Cal, California's state Medicaid system, uses a formulary list known as "Code 1" drugs, which spells out restrictions for each listed drug, including restrictions related to diagnoses. Certain Code 1 drugs are approved for reimbursement only for approved diagnoses, and pharmacies are supposed to certify that these Code 1 drugs are dispensed for the approved diagnoses, the DOJ said.
"Walmart may bill for drugs prescribed outside of the approved diagnoses only if it submits a request to the Department of Healthcare Services that includes a justification for the non‑approved use," the DOJ said.
The $1.65 million agreement settles allegations that Walmart failed to confirm and document the necessary diagnoses, and also at times gave out drugs for non-approved diagnoses, then billed Medi-Cal for them, the DOJ said.
The whistleblower lawsuit filed against Walmart by a pharmacist who has worked at Sacramento-area Walmart stores. As allowed by The False Claims Act whistleblower in this matter will be paid roughly $264,000 of the recovery proceeds.
Twitter: @BethJSanborn
