Automatic refills billed to Medicaid are illegal in Minnesota

On Behalf of | Mar 26, 2019 | Blog |

Prescription auto-refill programs are essential for many patients. It means they can have their prescriptions ready on time and be able to pick them up without delays each month.

There are issues related to fraud that can occur with auto-refill programs, though. The programs aren’t popular among regulators because they create waste, stockpiling and end up costing the federal programs more money when they are charged for unnecessary or unneeded prescriptions.

In the past, Wal-Mart and Sam’s Club had to pay $825,000 to the Minnesota Attorney General and the federal Department of Justice for claims that they automatically refilled prescriptions and then billed Medicaid without a patient’s authorization.

Now, Minnesota has banned pharmacies from billing Medicaid for autofills. Medicaid considers these fills as non-covered services, which are false claims and can result in penalties for pharmacies.

Why don’t they stop automatic refills completely?

There is no question that prescription refills set to automatic are beneficial to many patients, especially those with chronic illnesses. It’s been shown that automatic refills help with patient adherence and guarantee that their medications are ready when they need them. If patients always had to fill each time they ran out of a medication, the pharmacy could be out of the drug or make them wait longer than they can afford to.

What happens if someone blows the whistle on pharmacies that bill for medications on auto-refill?

If the billing is going to Medicaid, it’s a serious offense due to the statewide ban. The individual who reports the fraud will be considered a whistleblower, and they will receive whistleblower protections.

It is illegal to fire someone who is a whistleblower for making a legal report about the company. As long as their intentions were in good faith, then there is no reason for the employer to retaliate.

If you do file a claim to alert the government to fraudulent activities and are fired afterward as a result of your actions, then it is your right to sue for wrongful termination. You can then seek compensation from your past employer for their illegal act of terminating your position, ask that you be reinstated or seek other resolutions to the situation.

As an added benefit, you will receive a portion of any proceeds received as a result of alerting the government to your employer’s fraudulent actions, which can further support you financially if you’re wrongfully terminated for the report.