Puerto Rico Pharmacies Pay $4.6 Million in Medicare Medicaid Fraud Settlements

SAN JUAN, Puerto Rico — Four Puerto Rico pharmacies and their owners have paid more than $4.1 million to resolve federal allegations of Medicare and Medicaid fraud, the U.S. Attorney’s Office for the District of Puerto Rico announced on June 4, 2026.

The settlements cover conduct that occurred in the Medicare program, which provides health insurance to 65 million Americans including 900,000 beneficiaries in Puerto Rico, and the Medicaid program, which covers low-income residents and is jointly funded by federal and territorial governments.

The pharmacies agreed to pay a total of $4.6 million, with $4.1 million already recovered between February 26 and May 28 2026, per the Department of Justice release.

The agreements shift the pharmacies from active targets of fraud probes to entities that have satisfied civil claims under the False Claims Act. The owners now face automatic review for exclusion from participation in Medicare, Medicaid, and all other federal health care programs, a status that bars billing for any covered services for a minimum of five years once imposed.

Downstream, the owners must immediately update their enrollment records with the Centers for Medicare & Medicaid Services and prepare for potential program exclusion hearings. The pharmacies lose eligibility to receive new federal reimbursements until any exclusion periods end.

Federal auditors will treat the settlements as established overpayment determinations, requiring the pharmacies to adjust future cost reports and subjecting them to heightened scrutiny in any subsequent audits. The Department of Health and Human Services Office of Inspector General must now decide within statutory timelines whether to exclude the owners or negotiate corporate integrity agreements as a condition of continued participation.

This recovery forms part of an ongoing federal enforcement initiative targeting pharmacy fraud in Puerto Rico’s federally funded health programs. The June 4 announcement follows similar civil settlements and False Claims Act resolutions in the territory over the past two years that have collectively returned more than $20 million to the Medicare and Medicaid trust funds.

Primary sources: U.S. Department of Justice