PRESS RELEASE
CVS Pharmacy Inc. Pays $18.2 Million to Resolve Alleged False Claims Act Violations
Published by the United States Department of Justice | View article on www.justice.gov
U.S. Attorney's Office, Eastern District of California
CVS Pharmacy Inc. has paid a total of $18,282,280 to the United States and the State of California to resolve allegations that the company violated the Federal False Claims Act and the California False Claims Act when it knowingly submitted claims for reimbursement for certain prescribed medications to California’s Medi-Cal program that were not supported by applicable diagnosis and documentation requirements, U.S. Attorney Eric Grant announced today.
OAKLAND — California Attorney General Rob Bonta, in collaboration with the United States Department of Justice, today announced a settlement with national pharmacy chain CVS Pharmacy, Inc. (CVS) over its alleged violations of the California False Claims Act. The settlement resolves allegations that between 2010 and 2021, CVS submitted pharmacy claims to Medi-Cal using false electronic certifications that certified that patients had medical conditions qualifying for the payment of pharmaceutical drugs under Medi-Cal. CVS knowingly failed to verify or document mandatory compliance for a large number of claims, resulting in the payment of millions of dollars of false claims by Medi-Cal. The settlement agreement requires CVS to pay $18.2 million.
U.S. Attorney Announces $37.76 Million Settlement With CVS For Over-Dispensing Insulin Pens To Patients
Published by the United States Department of Justice | View article on www.justice.gov
CVS Pharmacy, Inc. Admits to Dispensing More Insulin to Patients Than They Needed and Receiving Ineligible for Reimbursements
United States Attorney for the Southern District of New York, Jay Clayton, Special Agent in Charge of the New York Regional Office of the U.S. Department of Health and Human Services Office of the Inspector General (“HHS-OIG”), Naomi D. Gruchacz, Acting Special Agent in Charge of the Northeast Field Office of the Defense Criminal Investigative Service (“DCIS”), Christopher M. Silvestro, and Special Agent in Charge of the U.S. Office of Personnel Management Office of the Inspector General (“OPM-OIG”), Derek M. Holt, announced that the United States has filed and settled a healthcare fraud lawsuit against national retail pharmacy chain CVS PHARMACY, INC. (“CVS”). The settlement resolves allegations that, from 2010 through 2020, CVS violated the False Claims Act in connection with its billing and dispensing of insulin pens to patients enrolled in Government healthcare programs (“GHPs”), including Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program. Specifically, the Government alleges that CVS improperly requested and received GHP reimbursement for premature refills, dispensed more insulin pens than patients needed according to their prescriptions, and falsely under-reported the days-of-supply of insulin that its pharmacies dispensed.
ENFORCEMENT ACTIONS
CVS Pharmacy Inc. Pays $18.2 Million to Resolve Alleged False Claims Act Violations
Penalty Amount: $0
Filed under: Criminal and Civil Actions, State Enforcement Agencies
U.S. Attorney's Office, Eastern District of California
CVS Pharmacy Inc. has paid a total of $18,282,280 to the United States and the State of California to resolve allegations that the company violated the Federal False Claims Act and the California False Claims Act when it knowingly submitted claims for reimbursement for certain prescribed medications to California’s Medi-Cal program that were not supported by applicable diagnosis and documentation requirements, U.S. Attorney Eric Grant announced today.
OAKLAND — California Attorney General Rob Bonta, in collaboration with the United States Department of Justice, today announced a settlement with national pharmacy chain CVS Pharmacy, Inc. (CVS) over its alleged violations of the California False Claims Act. The settlement resolves allegations that between 2010 and 2021, CVS submitted pharmacy claims to Medi-Cal using false electronic certifications that certified that patients had medical conditions qualifying for the payment of pharmaceutical drugs under Medi-Cal. CVS knowingly failed to verify or document mandatory compliance for a large number of claims, resulting in the payment of millions of dollars of false claims by Medi-Cal. The settlement agreement requires CVS to pay $18.2 million.