Attorney General William Tong has announced a $36.5 million multistate settlement with CVS Pharmacy, Inc. resolving allegations that the pharmacy chain knowingly submitted false claims to Medicaid and other government health programs related to the over-dispensing of insulin pens over a decade-long period.
The settlement, reached among Connecticut, the United States, the District of Columbia, and 35 other states, covers alleged conduct from 2010 through 2020. Allegations include that CVS improperly sought reimbursement for premature insulin pen refills, dispensed more pens than patients needed under their prescriptions, and falsely under-reported days-of-supply of insulin dispensed. Government health programs (GHPs) affected include Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program. As part of the settlement, CVS admitted and accepted responsibility for certain conduct, including that GHPs paid for insulin pen refills ineligible for reimbursement and that CVS dispensed more pens than beneficiaries needed.
"Over a decade, CVS over-billed our public healthcare programs for huge quantities of insulin pens, filling refills too early, too often, and too many," said Attorney General Tong. "In coordination with states across the country and our federal law enforcement partners, we are holding CVS accountable. We will continue to act aggressively to protect taxpayer dollars and the integrity of our healthcare programs."
Of the $36.5 million settlement, up to $25,108,480.45 is allotted to participating states' Medicaid programs, comprising up to $12,050,232.28 for the states and $13,058,248 for the United States. Connecticut's share of the multistate settlement is $1,089,945.85, of which the state-only portion is $633,913.76.
The settlement resolves allegations in five federal qui tam actions and was investigated by a National Association of Medicaid Fraud Control Units (NAMFCU) team in conjunction with the United States Attorney's Office for the Southern District of New York, with attorney representatives from California, Florida, New York, and Wisconsin.
