In 2015 and 2016, Virginia had a prior-authorization requirement which wrongly restricted patients’ eligibility for certain hepatitis C medications. This led many to seek fraudulent documents in a different state in order to obtain the medication. The government criminally charged a Tennessee Walgreen’s clinical pharmacy manager and one of her employees who falsified documents for Virginia patients.
Now, the government wants to collect treble damages of nearly $800,000 from Walgreens for the medications dispensed — medications that patients would have been wrongly denied under the illegal prior-authorization requirement.
The Litigation Center of the American Medical Association and State Medical Societies, the Medical Society of Virginia, and the US Chamber of Commerce say there is no basis for the government’s claim under the False Claims Act and that it is “contrary to Medicaid’s goal of providing prescription drug coverage to needy citizens.”
“The government’s argument that an FCA defendant cannot assert the illegality of a funding condition effectively means that states that impose unlawful conditions on the receipt of Medicaid assistance are entitled to keep their ill-gotten gains (and in fact treble them),” the amicus brief filed by AMA Litigation Center, MSV and the Chamber of Commerce said. “Accepting those arguments would incentivize governments to impose illegal funding conditions, with the consequence of denying care to patients who depend on Medicaid.”
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