On April 7th, the Department of Justice announced that Medcare Clinic and Pharmacy, LLC agreed to a settlement for alleged violations of the False Claims Act. The government alleged that Medcare “knowingly billing federal health care programs for medications that were never dispensed.” The North Carolina company based in Indian Trail agreed to pay the government $213,677.
The U.S. Government learned of the potential taxpayer waste and healthcare fraud from two whistleblowers who are former employees of Medcare. The whistleblowers, Brittanie Henry and Zilphia Adcock, brought the claims forward under the qui tam provisions of the False Claims Act. Qui tam claims enable private citizens to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. Qui tam whistleblowers are eligible to receive between 15 and 30% of the government’s recovery. In this case, the whistleblowers were awarded $53,419.43.
According to the press release from the Department of Justice, from 2016 to 2019 MedCare billed subsets of the federal programs Medicare and Medicaid for 200 prescription medications that MedCare never distributed to clients. The company’s inventory records showed that MedCare did not buy enough of those medications to fill all of the prescriptions billed to the programs.
Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, explained that “pharmacies may bill only for medications that they actually sell.” He touted the government’s commitment to stopping fraud and waste: “our office will continue to pursue entities that knowingly and unjustly enrich themselves at the taxpayers’ expense.”
U.S. Attorney Dena J. King for the Western District of North Carolina expressed a similar sentiment about the importance of catching False Claims Act violations: “When pharmacies bill government programs for prescriptions that are not disbursed to patients, taxpayer dollars are wasted and finite resources are diverted from beneficiaries in need.” She added that ““Our office will continue to work with our state and federal partners to investigate and hold accountable those who seek to profit from fraud on federal health care programs.”
North Carolina’s Attorney General submitted an additional press release sharing how the state’s Medicaid Investigations Division (MID) helped with the case. North Carolina is one of many states with its own False Claims Act that acts in conjunction with the federal law. North Carolina boasts that its MID has recovered more than $1 billion in restitution and penalties for the state.
Further Reading:
North Carolina Pharmacy Agrees to Resolve False Claims Act Allegations