FBI Near Settlement With "Major" Drug Chain Over Partial Rx Fills

An FBI investigation into pharmacy reimbursement practices related to partially filled prescriptions is nearing a settlement with a "major" drug store chain, FBI Health Care Fraud Unit Chief Timothy Delaney told the Health Care Compliance Association annual congress April 23 in Washington, D.C.

"The pharmacy is committing fraud, such as filling the bottle with 90 pills and billing for 100," Delaney explained.

FBI is "in negotiations right now with a major regional pharmacy chain somewhere in the country to settle a case just like that," he said.

Partial filling practices at Eckerd and Rite Aid are currently being investigated by the U.S. government.

Eckerd's reimbursement practices related to partially filled scripts were the subject of a February 1998 complaint filed by the Department of Justice and the state of Florida. In denying any fraudulent or intentional conduct, Eckerd said partially filling prescriptions is an "industry-wide practice." The government is continuing to request information from Eckerd.

Rite Aid is "being investigated by multiple state attorneys general for its reimbursement practices relating to partially filled prescriptions and fully filled prescriptions that are not picked up by ordering customers," the company stated in recent SEC filings. The company "is supplying similar information with respect to these matters to the Department of Justice."

The electronic claims processing standards used by chain drug stores have been the focus of several past DoJ investigations.

In 1999, Walgreens agreed to settle a DoJ complaint over its partial fill policy for $7.6 mil. Under a four-year corporate integrity agreement, the company also agreed to implement computer system changes, develop a new training program for pharmacy staff and conduct annual audits of its billing, claims submission and compliance practices.

The west coast chain Longs entered a three-year integrity agreement and paid $600,000 in 1996 as a result of a partial fill policy investigation. Corporate integrity agreements appear to be an increasingly frequent part of pharmacy fraud settlements (¹ (Also see "Rx Fraud Cases: IG Integrity Agreements May Be As Costly As Settlements" - Pink Sheet, 30 Apr, 2001.)).