Pharmacists are particularly well suited to discover Medicaid fraud relating to the medicines they dispense. A number of successful False Claims actions have been taken by pharmacists which have resulted in millions of dollars in recovered taxpayer dollars
and a percentage of the recovery to the pharmacists. One pharmacist became a whistleblower after discovering drug switching in the processing of transfers of prescriptions from Walgreens pharmacies. The Complaint says the pharmacist discovered the fraud after seeing a Walgreens prescription for ranitidine capsules rather than tablets, the industry standard. A Walgreens pharmacist told him that the pharmacy chain had set up a system to fill all ranitidine prescriptions as capsules regardless of what the physician had prescribed. Interestingly, the same pharmacist also successfully pursued a claim against CVS pharmacies arising out of drug switching resulting in a $37 million settlement. The total recoveries approached $90 million for which the whistleblower is entitled to 25% of
the recovered funds. In another case, two veteran pharmacists helped to recover $84 million in a False Claims
case against Merck-Medco Managed Care, L.L.C. a Pharmacy Benefit Manager engaged in government fraud. The complaint alleged that the company engaged in fraudulent drug utilization reviews and unlawfully cancelled prescriptions, created false records of physician contacts and used technicians to perform functions requiring pharmacists.
