The government accused Walmart pharmacies of failing to confirm and document the necessary diagnoses for “Code 1” drugs and then billing the Medi-Cal program for the prescriptions. Medi-Cal provides reimbursement for certain “Code 1” drugs only for approved diagnoses, and pharmacies serve as gatekeepers in this process.
“These Medi-Cal regulations are essential to protect both patients and limited healthcare funding,” said U.S. Attorney Phillip A. Talbert. “My office will continue to hold pharmacies accountable when they fail to comply with regulations like these.”
The allegations against Walmart were originally brought under the qui tam, or whistle-blower, provisions of the False Claims Act by a Walmart pharmacist.
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