Walgreens has agreed to pay $106 million to settle lawsuits that alleged the pharmacy chain submitted false payment claims with government health care programs for prescriptions that were never dispensed.
The settlement announced on Friday resolves lawsuits filed in New Mexico, Texas and Florida on behalf of three people who had worked in Walgreens’ pharmacy operation. The lawsuits were filed under a whistleblower provision of the False Claims Act that lets private parties file case on behalf of the United States government and share in the recovery of money, the U.S. Justice Department said. The pharmacy chain was accused of submitting false payment claims to Medicare, Medicaid and other federal health care programs between 2009 and 2020 for prescriptions that were processed but never picked up.
In a statement, Walgreens said that because of a software error, the chain inadvertently billed some government programs for a relatively small number of prescriptions that patients submitted but never picked up.
“Inadvertently” is carrying a lot of weight there.
I could pretty easily see how such a bug could happen if the description in the article is accurate.
The right way to do it is to have the entire transaction in some pending state, and nothing is permanently saved anywhere until the transaction is completed. (This is called an atomic operation. It usually applies to distributed databases, but the same concept applies here, where the transaction takes a long time to succeed or fail.)
If, instead, you add it to the “reimbursement list” while putting the actual “make the pill” and billing part in the pending state, then forget to remove it when the transaction isn’t completed, you get the outcome described in the article.
This would make sense on a smaller operation without a huge dedicated accounting team, fact that whistleblowers had to testify to fix it makes me doubt that’s the case.
They get a cash payout as a whistleblower. I could easily see not reporting it directly and reporting it through the channels that pay them instead. Also, if they contracted out, they may not have anyone with the basic understanding of tech to identify the issue even if “these requests shouldn’t have been filed” was reported up the chain.
It’s still negligence, but it doesn’t have to be deliberate fraud.
I mean, it’s possible that the software bug happened organically, but certainly at some point in the last decade management must have heard about it.
This is what I am saying. It stops being an accident and instead a cover-up the moment anyone in management knows about it.