A recent Rite Aid whistleblower lawsuit alleged that the company knowingly made false claims to California’s Medi-Cal program. Most of the lawsuit’s claims were allowed to proceed over Rite Aid’s motion for dismisal.

A California federal judge found that the state has met its initial burden to show that the pharmacy giant failed to properly oversee employees in charge of keeping prescription records, allowing them to submit false prescription reimbursement claims. U.S. District Judge Kimberly J. Mueller said that California had a burden to show that Rite Aid failed to adhere to state regulations of record-keeping for Code 1 drug prescriptions.

For Code 1 prescriptions, pharmacies must ensure that patients meet requirements for age, quantity, drug therapy, treatment duration, and illness.

However, the Rite Aid whistleblower lawsuit alleged that Rite Aid failed to properly review patient diagnoses before filling prescriptions, and would actually fill prescriptions even when a patient was not eligible for the medication, failing to document the Code 1 review process.

“Here, California has alleged sufficiently particular details of a scheme to submit claims for Code 1 drug prescriptions in which Rite Aid did not comply with Code 1 requirements, by delegating Code 1 compliance to its employees then failing to conduct even ‘a limited inquiry’ to ensure compliance,” said Judge Mueller.

A state audit allegedly found hundreds of claims in which the company never conducted a diagnosis review in accordance with Code 1 prescription requirements, according to the Rite Aid whistleblower lawsuit.

The Rite Aid whistleblower lawsuit was filed by plaintiff Loyd S., who alleged that the company allowed computer systems and poorly trained technicians to make review decisions for Code 1 drugs that should have been made by higher-paid pharmacists. As a result, the company took in Medicaid reimbursements it was not qualified for while also dispensing addictive drugs like Vicodin without following Code 1 drug prescription requirements.

The Justice Department is often tipped off about False Claims Act litigation by interference from a whistleblower.

Filing a Whistleblower Lawsuit over Medicaid and Medicare Fraud

If you have witnessed some kind of Medicaid and Medicare fraud by your employer against the federal government, you may be able to file a whistleblower lawsuit.

Whistleblowers are individuals who report the fraud and illegal activities against the government of their current or former employers. Many employees choose to come forward as whistleblowers because they do not feel right about their employer’s actions. A whistleblower lawsuit can be filed while working at the company, but can also be filed after having left the company. Employees who take the risk of blowing the whistle are entitled to certain legal protections from whistleblower retaliation.

A person considering becoming a whistleblower on behalf of the government may worry about being fired or otherwise retaliated against at work. However, there are regulations in place to protect whistleblowers from this kind of retaliation.

While a person considering becoming a whistleblower may be worried that they will face retaliation for their actions in reporting Medicaid and Medicare fraud, the whistleblower is typically given a whistleblower award—often between 15 and 30 percent of the money recovered in the subsequent lawsuit.