The Department of Justice has launched a number of enforcement actions targeting pharmacies for alleged violations of the False Claims Act (FCA). Recently, Walgreens has been the subject of two noteworthy government settlements related to alleged FCA violations.
In the first, on March 27, 2025, the U.S. Attorney’s Office for the District of Massachusetts announced that it had reached a $2.8 million settlement with Walgreens concerning allegations that the company overbilled Medicaid programs in Massachusetts and Georgia. Relators filed the qui tam case in 2019 and the government intervened for settlement purposes. The United States, Massachusetts, and Georgia alleged that, from 2008 to 2023, Walgreens submitted claims to MassHealth (Massachusetts’ Medicaid program) and Georgia Medicaid for certain generic medications that were higher than the customary price point for those drugs. Doing so, the government alleged, violated the federal FCA, as well as the states’ respective False Claims Acts.
Medicaid programs reimburse pharmacies for dispensing generic medications using the lowest of four reporting price points, one of which is the pharmacy’s “usual and customary price” as determined by the pharmacy. In this case, Walgreens submitted a higher price for the generic medications and failed to report the correct “usual and customary price,” causing the states’ Medicaid programs to overpay for those generic...
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