Ahold Delhaize U.S. agrees to pay $40 million in healthcare claims pricing settlement

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Ahold Delhaize $40M settlement

Highlights

Ahold Delhaize USA agreed to pay $40 million to resolve allegations it reported inflated 'usual and customary' drug prices to federal healthcare programs.
$32.9 million of the settlement goes to the federal government with the remainder allocated to participating states, and no liability was determined.
Whistleblower Lawrence LaBenne will receive $6,083,587 of the federal share, highlighting continued government focus on pharmacy pricing and whistleblower enforcement efforts.

Settlement terms and alleged pricing conduct

As reported by the U.S. Department of Justice, the agreement resolves allegations that Ahold Delhaize USA Inc. reported inflated “usual and customary” drug prices on claims to federal healthcare programs, in violation of the False Claims Act and related state laws. The company, which is headquartered in Quincy, Massachusetts, operates in-store pharmacies under banners including Giant, Hannaford, Stop & Shop and Food Lion.

The United States alleges that Ahold Delhaize ran prescription savings programs that offered enrolled members discounted drug prices, and that those discounted prices should have been reported as the “usual and customary” prices for reimbursement purposes. Because those reported prices serve as ceiling prices in payment formulas for Medicare Part D, Medicaid and TRICARE, the government contends the pharmacies caused those programs to pay inflated amounts on certain claims.

Of the $40 million settlement announced, $32.9 million goes to the federal government, while the remainder is allocated to participating states. The Justice Department says the claims resolved by the settlement are allegations only, and there has been no determination of liability.

Whistleblower payout and fraud enforcement implications

The civil settlement also resolves a whistleblower case brought by Lawrence LaBenne, a pharmacist at an Ahold Delhaize supermarket in Pennsylvania, under the qui tam provisions of the False Claims Act. LaBenne is set to receive $6,083,587 from the federal share of the recovery in the case filed in the Western District of Pennsylvania.

Justice Department and healthcare oversight officials say the case underscores the government’s focus on pharmacy pricing accuracy in taxpayer-funded programs. Officials from the Justice Department, the U.S. Attorney’s Office for the Western District of Pennsylvania and HHS-OIG say they continue to target conduct that can raise costs for Medicare, Medicaid and TRICARE, highlighting whistleblower actions as a key tool in broader healthcare fraud enforcement.

Our earlier article on the Stopping Fraudulent Payments Act (H.R. 8464) explained how House Republicans want to strengthen pre-payment screening across federal programs by requiring agencies to run fraud checks before submitting payment requests. The proposal would also give the U.S. Treasury clearer authority to halt and return payments flagged as high-risk, with regular reporting to Congress to improve oversight and reduce losses tied to waste, fraud and abuse.

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