Regional Pharmacy Chain Discovers Billing Overcharges And Voluntarily Repays Massachusetts Medicaid Program

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Pharmacy / Pharmacist
Article Date: 06 Oct 2008 - 2:00 PST

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Today, regional pharmacy chain The Stop & Shop Supermarket Company LLC (Stop & Shop) has voluntarily returned $269,000 to the Massachusetts Medicaid Program, MassHealth, after the company conducted a self-audit and determined it had been overpaid for pharmacy charges it submitted to MassHealth.

"Pharmacies hold a position of trust with their patients and members of the community at large," Attorney General Martha Coakley said. "We commend Stop & Shop for living up to those high expectations by bringing this overpayment to the attention of MassHealth."

Stop & Shop , which operates pharmacies in Massachusetts and is based in Quincy, discovered during an audit in 2006 that it had not reported the lowest price it had accepted for certain prescription drug products to MassHealth. By not reporting the lower prices to MassHealth, Stop and Shop was overpaid by $269,000. Massachusetts law requires pharmacies to charge Medicaid no more than the lowest price they are willing to accept from any "payer." If the pharmacies' price is lower than the price calculated by the state's pricing formula, then the state will pay the lowest price.

Stop & Shop inadvertently did not report the lowest price in claims that were filed with the state between July and December 2005. Upon discovering the error, Stop & Shop notified MassHealth, who then notified the Attorney General's Office in March 2007. MassHealth and the Attorney General's Medicaid Fraud Division then examined Stop & Shop's findings and determined that the reported overpayment from the self-audit was accurate.

The matter was handled by Assistant Attorney General Peter Clark of Attorney General Coakley's Medicaid Fraud Division.

Office of Massachusetts Attorney General Martha Coakley