Dive Brief:
- Ahold Delhaize USA has agreed to pay $40 million to resolve allegations that it violated the False Claims Act by reporting inflated drug prices on claims to federal healthcare programs, according to a Wednesday press release from the Department of Justice.
- The U.S. contended that the grocer’s in-store pharmacies failed to accurately report discounted prescription drug prices as their “usual and customary” prices on claims to Medicare Part D, Medicaid and Tricare, leading the programs to pay inflated amounts on the claims.
- This news comes shortly after ADUSA’s parent company told investors during an earnings call that it anticipates taking an approximately $450 million impact on reported and comparable sales for 2026 from pharmacy pricing changes.
Dive Insight:
The alleged actions by ADUSA came to light from whistleblower Lawrence LaBenne, who was a pharmacist at one of the company’s Pennsylvania locations. He will receive more than $6 million as part of the civil settlement.
The U.S. government stated that ADUSA submitted claims for inflated drug prices to federal programs like Medicare and Medicaid instead of the discounted prices it actually offered to eligible members, per the press release.
“If pharmacies report inflated ‘usual and customary’ prices on claims to federal healthcare programs, the programs pay more than they should on those claims,” Brett Shumate, assistant attorney general with the Justice Department’s Civil Division, said in a statement.
Of the $40 million ADUSA is paying to resolve the allegations, $32.9 million will go to the federal government, with states that participated in the settlement receiving the rest.
Under the False Claims Act, private parties can file an action on behalf of the U.S. and receive a portion of the recovery. The$6 million LaBenne will collect is included in the federal share of the settlement.
In a statement, Ahold Delhaize USA said it’s ready to move past the settlement.
“We have admitted no wrongdoing in this matter and have fully cooperated with the government throughout the review of these government billing questions related to programs discontinued nearly a decade ago,” a spokesperson for the grocery company said in an emailed statement. “Through each of our local brand pharmacies, we remain committed to serving the local needs of customers in the communities we serve and providing the care needed for their well-being.”
Early last month, Ahold Delhaize CFO Jolanda Poot-Bijl said that both net and comparable sales for the company’s first quarter were negatively impacted by several factors, including the Inflation Reduction Act’s impact on pharmacy pricing.
