Ahold Delhaize USA Inc. agreed on June 10 to pay $40 million to settle federal and state claims that its pharmacy pricing reports caused Medicaid, Medicare and TRICARE to overpay for prescription drugs. The United States Department of Justice said the deal resolves allegations that lower discount prices offered in some store pharmacies were not reflected in the prices reported to government health programs.
The federal government will receive about $32.9 million of the recovery, with the rest going to participating states. Lawrence LaBenne, who worked as a pharmacist at an Ahold Delhaize supermarket in Pennsylvania, is set to receive roughly $6.1 million as the whistleblower who brought the case, a common share in False Claims Act settlements that reward inside reporting when the government recovers money.
At the center of the case was a pricing rule that should have mattered every time a covered prescription was billed. The DOJ said Ahold Delhaize supermarkets with in-store retail pharmacies ran discount programs for enrolled members, but those lower prices were not accounted for when the company billed federal health care programs. The government’s theory was simple: if the reported “usual and customary” price did not reflect the lower price actually available to customers, the programs paid too much on covered prescriptions.
The settlement closes U.S. ex rel. LaBenne v. Koninklijke Ahold Delhaize N.V., et al., Civil Action No. 18-CV-925 in W.D. Pa., but only as to allegations. There has been no determination of liability, and that distinction matters because the company agreed to pay rather than to a finding that it broke the law. In practical terms, the case is over for now, the money is divided, and the disputed question of fault remains unresolved in the record.
For LaBenne, the deal ends a case that began in 2018 with a pharmacist’s complaint from inside an Ahold Delhaize supermarket in Pennsylvania. For the government, it is a recovery from a reporting practice that allegedly touched three major public health programs at once, with the next and final step being the distribution of the settlement funds, not another round of litigation.
