Worcester Pharmacy to Pay $1.6 Million Over Claims of Operating an Unauthorized Automatic Refill Program
BOSTON – A pharmacy based in Worcester has agreed to pay $1.6 million to settle allegations that it improperly billed and received payments from the state’s Medicaid program when it automatically refilled prescription medications that were not specifically requested by MassHealth patients, Attorney General Martha Coakley announced today.
Under the terms of the settlement, AllCare Pharmacy will pay $1.6 million in restitution to the Commonwealth and be subject to additional reporting requirements to ensure compliance in the future. The settlement is the first case in the Commonwealth to address a pharmacy’s operation of an improper automatic refill program with MassHealth members.
“MassHealth is a program that provides critical health care services for some of our most vulnerable residents,” AG Coakley said. “Our office is pleased that this resolution will provide restitution to both MassHealth and taxpayers as we continue our efforts to recover funds for the Commonwealth.”
AllCare was initially referred to the AG’s Office by MassHealth in March 2011. The investigation conducted by the AG’s Office determined that AllCare – between October of 2008 and July of 2012 – implemented an “automatic refill” program since its inception which expressly violated MassHealth regulations. Current regulations prevent any pharmacy in the Commonwealth from refilling a prescription that was not explicitly requested by a MassHealth patient or caregiver at the time of each filling event.
The Commonwealth alleges that automatic refill programs have resulted in MassHealth patients obtaining medications far in excess of what was utilized or needed, resulting in wasted government resources.
The matter was investigated by Assistant Attorney General Steven Sharobem, Investigator Christopher Cecchini and Investigator Aleksandra Andriyevskaya of Attorney General Martha Coakley’s Medicaid Fraud Division, with assistance from MassHealth.