Billerica pharmacy to pay $1.5M for Medicaid billing errors

BOSTON — A Billerica pharmacy has agreed to pay more than $1.5 million to settle allegations it improperly billed and received payments from the state’s Medicaid program when it automatically refilled prescription medications that were not requested by MassHealth patients or caregivers.

Neighborhood Diabetes, Inc., listed at 600 Technology Park Drive, unit 201, will pay more than $1.5 million in restitution to the state for the overpayments, and be subject to additional reporting requirements to ensure compliance in the future.

“We allege this pharmacy’s improper billing and refill practices resulted in unnecessary overpayments by MassHealth,” state Attorney General Maura Healey said in a statement. “Our office is pleased that this resolution will provide restitution and requires compliance with state regulations.”

The investigation by the Attorney General’s Office into the pharmacy’s refill and billing practices determined that Neighborhood Diabetes, Inc., operating under the name of Neighborhood Pharmacy, implemented an “automatic refill” program which expressly violated MassHealth regulations. Current regulations prevent any pharmacy in the state from refilling a prescription that was not directly requested for refill by a MassHealth patient or caregiver.

Neighborhood Pharmacy has also agreed not to refill or bill for prescription medications without an explicit request from a MassHealth member or caregiver, or refuse to dispense drugs to any MassHealth member who is unable to pay a co-payment at the time.

Neighborhood Pharmacy is also required to comply with all applicable state and federal statutes, and provide annual training to its employees who provide pharmacy services.

The settlement is the second case in the commonwealth to address a pharmacy’s operation of an improper automatic refill program with MassHealth members. In September 2013, AllCare Pharmacy in Worcester agreed to pay $1.6 million to settle similar allegations.

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Billerica pharmacy to pay $1.5M for Medicaid billing errors
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