Press Release  Massachusetts Pharmacy to Pay $340,000 Over Claims of Operating Unauthorized Automatic Refill Program

Boston — A pharmacy based in Bristol County has agreed to pay over $340,000 to settle allegations that it improperly billed and received payments from the state’s Medicaid program (MassHealth), Attorney General Maura Healey announced today.

Under the terms of the settlement, PharmaHealth Long Term Care Inc., PharmaHealth Specialty Long Term Care Inc., and PharmaHealth Hawthorne (collectively known as “PharmaHealth”), will pay over $340,000 to MassHealth to resolve allegations that it automatically refilled prescription medications that were not explicitly requested by MassHealth recipients.

“We allege that this company’s billing and refill practices were wasteful, unnecessary, and in violation of the law,” said AG Healey. “This settlement provides a payment back to MassHealth and is another example of our efforts to recover funds to the state and taxpayers.”

Current regulations prohibit pharmacies in Massachusetts from automatically refilling prescriptions that were not explicitly requested by a MassHealth patient or caregiver at the time of each filling event. The AG’s Office alleges that from 2009 through 2013, PharmaHealth automatically refilled prescriptions and billed MassHealth inappropriately for them.

The AG’s office has previously addressed the issue of a pharmacy’s operation of an improper automatic refill program with MassHealth members. AllCare Pharmacy paid $1.6 million to settle with the AG’s Office in 2013 and Neighborhood Diabetes paid  $1.5 million to settle with the AG’s Office in 2015 to resolve similar allegations of improper billing.

The office’s Medicaid Fraud Division works to prevent and prosecute provider fraud and violations of state law pertaining to the administration of the Medicaid Program, returning $45 million to MassHealth in 2017 alone.

The matter was investigated by Assistant Attorney General Anthony Vargas, Investigations Supervisor Christopher Cecchini and Investigator Aleksandra Andriyevskaya, all of AG Healey’s Medicaid Fraud Division, with assistance from MassHealth and the Board of Registration in Pharmacy.

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