By Peter.
CVS Health has agreed to pay $37.76 million to settle federal and state allegations that, for a full decade (2010–2020), its pharmacies systematically gave patients more insulin pens than doctors prescribed and then billed government programs for the extras.
The U.S. Attorney’s Office in Manhattan called it a clear violation of the False Claims Act.
What CVS Allegedly Did
- Doctors wrote scripts for, say, 60 days of insulin pens
- CVS pharmacies dispensed full cartons (often 90–100 days’ worth) anyway
- Staff were told to falsely report the maximum allowable days-of-supply so insurers would pay faster and refills could be triggered sooner
- Result: Medicare, Medicaid, TRICARE, and other federal programs were routinely overbilled for insulin patients never used
Breakdown of the $37.76M Settlement
- $24.45 million → U.S. government
- Remainder → participating states
- Whistleblowers (led by former CVS pharmacist Adam Rahimi, who filed in 2018) get 19.5 % (~$7.4 million), with Rahimi taking the lion’s share
CVS’s Response
“Insulin pen billing has long been a challenge for pharmacies” because of labeling changes, variable dosing, and payor rules. Recent PBM and tech improvements have fixed most of it. “We’re pleased to put this issue behind us.”
Translation: They’re not admitting guilt, but they’re writing a very large check to make it go away.
This is one of the biggest False Claims Act settlements ever tied specifically to insulin pen over-dispensing — and a stark reminder that even “routine” pharmacy shortcuts can cost tens of millions when government healthcare dollars are involved.
#CVS #InsulinPens #MedicareFraud #FalseClaimsAct #Whistleblower
