Seventh Circuit Holds Pharmacy Billing Medicaid For Drug Prices Above Private Rates Is Not Fraudulent 11/24/2014byKing & Spalding

On November 12, 2014, the Seventh Circuit upheld the dismissal of a False Claims Act action challenging a retail pharmacy chain’s practice of billing Medicaid for the price differential between the higher Medicaid-negotiated drug prices and the lower private insurance prices, holding that billing Medicaid for this price difference did not violate federal law. In Thulin v. Shopko Stores Operating Co., Case No. 13-3638, 2014 BL 318642 (7th Cir. Nov. 12, 2014), the circuit court held that Relator, a former pharmacist with Shopko Stores Operating Co., failed to prove his allegation that “Shopko submitted inflated claims for prescription drugs to the federal Medicaid program.”
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