Ahold Delhaize USA has agreed to pay $40 million to resolve allegations that it violated the False Claims Act and state analogs by reporting inflated “usual and customary” prices on claims submitted to Medicare Part D, Medicaid and TRICARE.
The Quincy, Mass.-based company operates supermarkets with in-store pharmacies, including chains under the Giant, Hannaford, Stop & Shop and Food Lion brands. Federal officials alleged the pharmacies failed to report discounted prescription prices available through savings programs as their “usual and customary” prices, causing federal healthcare programs to pay inflated amounts on certain claims, according to a June 10 Justice Department news release.
Reported “usual and customary” prices serve as ceiling prices in payment formulas used by Medicare Part D, Medicaid and TRICARE, according to the government. The settlement resolves allegations only, and there has been no determination of liability, according to the news release.
Of the $40 million settlement, $32.9 million will go to the federal government, with the remainder paid to participating states.
“Ahold Delhaize USA is pleased to have settled this matter with the Department of Justice,” a company spokesperson said in a statement to Becker’s. “We have admitted no wrongdoing in this matter and have fully cooperated with the government throughout the review of these government billing questions related to programs discontinued nearly a decade ago.”
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
