Oklahoma Pharmacies Settle Medicaid Case

Pharmacies Accused of Improper SoonerCare Billing

Nine independent Oklahoma pharmacies have agreed to pay $157,000 to resolve allegations that they billed the Oklahoma Medicaid Program, known as SoonerCare, for hundreds of unauthorized over-the-counter COVID-19 tests.The settlement follows a detailed investigation by the Attorney General’s Medicaid Fraud Control Unit, which uncovered the improper claims and coordinated with the Oklahoma Health Care Authority to ensure repayment.

The Attorney General’s Office stated that the pharmacies were reimbursed for tests not approved or authorized under program rules. Officials emphasized that even during the public-health emergency, Medicaid billing requirements remained in force, and providers were responsible for verifying that claims met state and federal guidelines.

Attorney General’s Office Emphasizes Accountability

Investigators said the pharmacies’ billing practices violated SoonerCare policy by charging for items not prescribed or otherwise covered.Although the violations did not rise to the level of criminal intent, state officials required full financial restitution to protect taxpayer dollars and uphold program integrity.

Attorney General Gentner Drummond praised the work of the Medicaid Fraud Control Unit, noting that “Oklahomans depend on honest providers to deliver essential health services, and our office will continue to ensure that public funds are spent responsibly.”

The settlement agreement also includes ongoing monitoring to prevent future violations. Pharmacies involved in the case have agreed to strengthen internal billing oversight and adopt new verification procedures for over-the-counter medical items.

Medicaid Fraud Control Unit’s Broader Effort

The Medicaid Fraud Control Unit investigates and prosecutes provider fraud and patient abuse in facilities receiving Medicaid funds.The unit’s work has led to the recovery of millions of dollars in improperly spent Medicaid money and has protected vulnerable populations who rely on SoonerCare for essential healthcare access.

Officials said this case is part of a broader push to maintain transparency and public trust in Oklahoma’s healthcare system.The agency urged anyone suspecting Medicaid fraud to report violations through the Attorney General’s website or the Medicaid Fraud hotline.

By holding pharmacies accountable, Oklahoma reaffirms its commitment to honest billing practices and ethical healthcare operations statewide.

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