Ahold Delhaize USA Inc. to Pay $40M for Allegedly Reporting Inflated Drug Prices on Claims to Federal Healthcare Programs

Ahold Delhaize USA Inc. (Ahold Delhaize), headquartered in Quincy, Massachusetts, has agreed to pay the United States and participating states a total of $40 million to resolve allegations that it violated the False Claims Act and state analogs by reporting inflated “usual and customary” prices on claims to federal healthcare programs. The United States alleged that Ahold Delhaize supermarkets with in-store retail pharmacies – including supermarket chains operating under the names Giant, Hannaford, Stop & Shop, Food Lion, and others – operated prescription savings programs pursuant to which enrolled members received discounted prices on prescription drugs. The United States contends that, in light of the features and operations of those savings programs, and the applicable Medicare Part D, Medicaid, and TRICARE program requirements (including, where applicable, contractual requirements), the discounted prices should have been reported as “usual and customary” prices on claims submitted to Medicare Part D, Medicaid, and TRICARE. Reported “usual and customary” prices serve as ceiling prices on payments to pharmacies under the applicable healthcare program payment formulas. The United States contends that Ahold Delhaize pharmacies failed to accurately report their discounted prices as their “usual and customary” prices on claims to Medicare Part D, Medicaid, and TRICARE, causing those programs to pay inflated amounts on such claims. The Medicaid Program is jointly funded by the federal government and the states. Of the $40 million resolution announced today, the federal share is $32.9 million and the remainder will be paid to states participating in the settlement.