US EditionCVS Pays $18.3M To Resolve Alleged Medi-Cal Billing Failures - CVS Health (NYSE:CVS)
CVS agreed to pay $18.3 million to settle claims of improperly billing California's Medi-Cal program for medications without required diagnoses, resolving a whistleblower lawsuit.
- On Tuesday, U.S. Attorney Eric Grant announced a $18.3 million settlement with CVS Health Corp's CVS Pharmacy Inc. resolving allegations tied to Medi‑Cal billing, with Grant saying, `This settlement demonstrates our commitment to protect the integrity of this critically important federal-state program.`
- California's Medi‑Cal rules require a formulary for 'Code 1' medications needing specific diagnoses, while CVS Health Corp's CVS Pharmacy Inc. operates over 9,000 locations nationwide.
- Prosecutors allege CVS did not consistently verify required diagnoses and sometimes dispensed Code 1 drugs for unapproved uses, then submitted reimbursement claims to Medi-Cal without proper documentation.
- According to HHS‑OIG's Susan Gillin, the whistleblower will receive roughly $18.3 million of the recovery, DOJ said.
- Grant said the settlement underscores, `This settlement demonstrates our commitment to protect the integrity of this critically important federal-state program,` and officials noted the agreement ends claims that CVS improperly billed California's Medicaid program serving low-income residents and people with disabilities.
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12 Articles
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