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CVS Settles Medicaid Insulin Fraud Claims for $36.5 Million

A decade-long investigation into pharmacy billing practices has concluded with CVS agreeing to pay $36.5 million to resolve allegations of Medicaid fraud. The settlement, involving the Justice Department and 36 state attorneys general, addresses claims that the retail giant overbilled government programs for insulin prescriptions between 2010 and 2020.

CVS Settles Medicaid Insulin Fraud Claims for $36.5 Million

New York Attorney General Letitia James announced that the company knowingly dispensed excess insulin to customers while misrepresenting the amounts in its billing records. Out of the total settlement, $25.1 million will be distributed to Medicaid programs across participating states, with New York’s share totaling $2.3 million.

CVS representatives expressed satisfaction with the resolution, citing the inherent difficulty of navigating insulin dosing variability and complex payor supply limits. The company noted that it had reached the agreement in principle last December, effectively ending the litigation over its prescription reporting procedures.

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