From the Office of Public Affairs (Dept. of Justice): CVS Pharmacy Inc., a Rhode Island-based pharmacy chain, and its related corporate entities (collectively, CVS) have agreed to pay $315 million to resolve allegations that, from October 17, 2013 through December 2, 2025, CVS illegally filled prescriptions for opioids and other controlled substances in violation of the Controlled Substances Act (CSA), and then sought payment for many of those invalid prescriptions from Medicare and other federal healthcare programs in violation of the False Claims Act (FCA).
The settlement resolves allegations in the government’s complaint, which the United States filed on Dec. 13, 2024, in the U.S. District Court for the District of Rhode Island, that CVS knowingly filled prescriptions for controlled substances that lacked a legitimate medical purpose, were not valid, and/or were not issued in the usual course of professional practice. The United States alleged that CVS dispensed prescriptions for dangerous and excessive quantities of opioids, opioid prescriptions filled too early, and “trinity” prescriptions, a dangerous and abused combination of an opioid, a benzodiazepine, and a muscle relaxant. CVS also allegedly filled prescriptions for controlled substances from “pill mill” prescribers who issued large numbers of controlled substance prescriptions without any medical purpose. Further, the United States alleged that CVS pharmacists filled these prescriptions despite clear red flags indicating that there was a high likelihood that the prescriptions lacked a legitimate medical purpose, were not valid, or were not issued in the course of professional practice. Many of these prescriptions were ultimately billed to and reimbursed by federal healthcare programs.
The complaint further alleged that CVS’s violations stemmed from corporate-imposed performance metrics, incentive compensation, and staffing policies that prioritized corporate profits over patient safety. CVS failed to employ enough pharmacists to serve patients, comply with CVS’s legal obligations, and meet corporate performance metrics. In addition, CVS’s policies allegedly prevented pharmacists from warning one another about certain problematic prescribers.
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