St. Louis-based SSM Health Care has agreed to pay $939,290 to resolve allegations that employees at the retail pharmacy at Saint Louis University Hospital routinely waived patient copays, causing Medicare and the Federal Employees Health Benefits Program to overpay for prescriptions.
The settlement resolves allegations that from Sept. 1, 2020, through Feb. 28, 2023, pharmacy employees, including the pharmacist-in-charge, routinely waived and failed to collect copays, according to a June 24 news release from the Justice Department.
Federal officials said the routine waivers improperly induced patients to use the pharmacy and misrepresented the actual cost of prescriptions, resulting in inflated payments by Medicare and the Federal Employees Health Benefits Program in violation of the False Claims Act.
The settlement also includes $150,000 in attorneys’ fees and costs for the whistleblower who filed the lawsuit in 2023. The whistleblower will receive $159,210 of the settlement amount. The agreement contains no admission of liability by SSM, which federal officials said fully cooperated with the investigation and took remedial action.
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