CVS Paying $36.5 Million for Overbilling Medi-Cal for Insulin Pens

CVS is paying $36.5 million for submitting false claims to the Medi-Cal program for excessive dispensing of insulin pens.

A settlement pursued by California Attorney General Rob Bonta in collaboration with the United States Department of Justice with CVS Pharmacy, Inc. resolves allegations that between 2010 and 2020, CVS submitted fraudulent claims to Medi-Cal, giving patients more insulin than prescribed and lying about refill timelines to get paid for unauthorized, unnecessary medication. The settlement requires CVS to pay $36.5 million total with California’s share being more than $2.7 million.

According to Bonta’s office, CVS under-reported how many days insulin supplies should actually last, which tricked tracking systems into approving the premature refills. CVS also ignored rules that require pharmacies to use accurate usage data to calculate refill dates. As a result of these fraudulent claims, government programs ended up paying CVS for extra insulin that patients did not need and doctors did not authorize.

The settlement is the result of a joint effort by the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse and the U.S. Attorney’s Office for the Southern District of New York.