Pharmacy Ordered to Repay Nearly $1 Million to Medicaid

November 20, 2017

An independent community pharmacy was busted in a Medicare fraud investigation.

An independent community pharmacy in New Jersey agreed to repay more than $800,000 after a Medicaid fraud investigation.

Madison Avenue Pharmacy in Lakewood, NJ, along with its owner, will repay $878,083 to the Medicaid program after a pharmacy inventory analysis conducted by the New Jersey Office of the State Comptroller, Medicaid Fraud Division (MFD) revealed that the pharmacy was paid for claims for which it could not provide purchase invoices.

The settlement between Madison Avenue Pharmacy and MFD resolves all allegations resulting from the investigation, but does not amount to an admission of liability by the pharmacy, the New Jersey Office of the State Comptroller said in a statement.

The pharmacy must make the first payment of around $440,000 immediately, and then will have to make monthly payments of $73,000 each for six months.

“The pharmacy inventory investigations that we routinely conduct ensure that Medicaid funds are being spent appropriately,” said State Comptroller Phillip James Degman in the statement. “Through this process, our investigators verify that submitted claims are supported by proper documentation. When the pharmacy cannot provide sufficient documentation, we will act aggressively to pursue a recovery on behalf of the Medicaid program.”

MFD serves as the state’s independent watchdog for New Jersey’s various Medicaid programs and works to ensure that the state’s Medicaid dollars are being spent effectively and efficiently.

While MFD is settling the case with Madison Avenue Pharmacy, other federal and state agencies can pursue criminal charges against the pharmacy, according to the settlement.