Walgreens sued by BCBS payers, health systems for alleged drug overcharging fraud scheme

Blue Cross Blue Shield affiliates and other payers are suing Walgreens for allegedly overcharging payers and customers for prescription drugs.

Court documents filed March 15 in the U.S. District Court for the Northern District of Illinois Eastern Division claim that Walgreens "knowingly and intentionally engaged in an ongoing fraudulent scheme" to overcharge payers by submitting claims with artificially inflated drug prices.

The lawsuit alleges that Walgreens concealed the fraud scheme by making false statements and leaving out facts related to its true usual and customary prices for prescriptions given to the individuals enrolled in the plaintiff's health plans. The suit alleges that Walgreens overcharged payers and health systems by hundreds of millions of dollars for more than a decade by submitting falsely inflated usual and customary prices on millions of reimbursed claims.

The plaintiffs named in the suit are CareFirst of Maryland, Group Hospitalization and Medical Services, CareFirst BlueChoice, Blue Cross Blue Shield of South Carolina, BlueChoice HealthPlan of South Carolina, Louisiana Health Service and Indemnity Co., Blue Cross and Blue Shield of Louisiana, and HMO Louisiana.

The court documents say that plaintiffs are owed at least the amount of money they were overcharged on reimbursement claims.

The suit also says that Walgreens' alleged scheme affected consumers directly. By purchasing prescription drugs from Walgreens' pharmacies with falsely inflated prices, payers increased copays, coinsurance, deductibles and premiums.

The lawsuit claims that Walgreens' alleged fraudulent actions are still happening and that the company continues to report falsely inflated prices for payer claims. Because of this, the plaintiffs believe they are still threatened with future harm from Walgreens.

Walgreens declined to provide a comment to Becker's Hospital Review.

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