Walgreens must face US, Virginia Medicaid fraud lawsuit over hepatitis C drugs

[August 16, 2023]  By Jonathan Stempel

(Reuters) -A federal appeals court on Tuesday revived a lawsuit in which the United States and Virginia accused Walgreens Boots Alliance of defrauding Virginia's Medicaid program by falsely representing that some patients were eligible for expensive hepatitis C drugs.

In a 3-0 decision, the 4th U.S. Circuit Court of Appeals in Richmond, Virginia, cleared the way for the nation's largest pharmacy chain to face claims it violated the federal False Claims Act and Virginia state law.

The case arose from alleged misconduct by a clinical pharmacy manager at a Walgreens in Kingsport, Tennessee.

She was accused of falsifying patient records, including lab results, between January 2015 and June 2016 to obtain prior authorization from Virginia Medicaid for reimbursement for the drugs Sovaldi, Harvoni and Daklinza.

Revenue from the Kingsport store grew by 321% during that time, court records showed.

Walgreens began an investigation, but did not repay money it received for 12 Virginia Medicaid patients, even after the manager pleaded guilty to a similar scheme in Tennessee.

In December 2021, a trial judge dismissed the lawsuit, saying Walgreens' misrepresentations were immaterial because Virginia's prior authorization requirements violated federal law.

Pigeons are seen resting on signage for Walgreens, owned by the Walgreens Boots Alliance, Inc., in Manhattan, New York City, U.S., November 26, 2021. REUTERS/Andrew Kelly/File Photo

But in Tuesday's decision, Circuit Judge Albert Diaz said Walgreens' alleged misrepresentations were material under the False Claims Act because they "did, in fact, influence the decisionmakers" at Virginia Medicaid.

He also said Walgreens could not escape liability by attacking Virginia's eligibility requirements as illegal.

"Allowing Walgreens to avoid liability by challenging Virginia's eligibility criteria only after getting caught would hinder the act's purpose of holding fraudsters accountable," Diaz wrote.

Walgreens declined to comment.

The U.S. Department of Justice also declined to comment, while the office of Virginia Attorney general Jason Miyares did not immediately respond to requests for comment.

The case is U.S. et al v Walgreen Co, 4th U.S. Circuit Court of Appeals, No. 22-1491.

(Reporting by Jonathan Stempel in New York; Editing by Marguerita Choy and Jonathan Oatis)

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