The Massachusetts Attorney General's Office has announced settlements with two local pharmacies after accusations emerged of false billing practices aimed at the state's Medicaid program, MassHealth. Center Pharmacy in Granby and Boston's Galaxy Pharmacy, will cough up a combined total of $500,000 for restitution. The allegations pointed towards a pattern of Medicaid reimbursement hacking that put the pharmacies at odds with state law.
Between the rhythm of day-to-day operations and the complexities of pharmaceutical billing, both pharmacies seem to have strayed. The AGO's investigation unearthed that at Center Pharmacy, from August 2023 through October 2023, there were numerous false claims for a pricey prescription vitamin named Profola. According to a statement made by the Massachusetts Attorney General’s Office, "the pharmacy misrepresented to physicians that their elderly nursing home patients had requested Profola prescriptions, when they had not." Galaxy Pharmacy's indiscretions, on the other hand, date back to 2018, involving automated prescription refills that MassHealth members, nor their caregivers, had not explicitly asked for.
As part of their penance, both Center Pharmacy and Galaxy Pharmacy must now run a tight ship. This includes instituting a three-year independent monitoring program to ensure they don't make waves with MassHealth requirements again. Additionally, both are now compelled to upgrade those policies and procedures and to ferry their staff through trainings tailored to these updated protocols, showcased by annual record checks and on-site audits.
Skirting around the rules, these pharmacies have invited scrutiny from the AGO, with strong implications that such practices won't be tolerated. The Massachusetts False Claims Act and the Medicaid False Claims Statute, serve as the legal anchors these settlements are tied to. The team behind the Center Pharmacy investigations included Assistant Attorney General Mary-Ellen Kennedy, Investigations Supervisor Christopher Cecchini, and Investigator Emily Hunt with help from MassHealth. The Galaxy Pharmacy case saw Assistant Attorneys General Natalie Rutkowski and Patrick C. McCooe joining forces with Investigations Supervisor Christopher Cecchini, and Investigations Supervisor Shelby Stephens, each also of the AGO's Medicaid Fraud Division. Both divisions are supported with a blend of federal and state funds, to the tune of over $7.8 million for fiscal year 2025, the bulk of which hails from the U.S. Department of Health and Human Services.
These enforcement actions come on the heels of previous settlements, reflective of the AGO's ongoing crusade against misconduct within the public trust. November 2021 saw an $800,000 settlement with Bravo Pharmacy, and back in September 2020, Remedium Pharmacy was set back by $500,000. These are harbingers—warning shots to health care providers that when it comes to defending MassHealth's integrity, the Commonwealth’s patience is not infinite.
