CVS Pharmacy Inc. has settled alleged violations of the California False Claims Act with California Attorney General Rob Bonta and the United States Department of Justice.
The settlement agreement requires CVS to pay $18.2 million. It resolves allegations that between 2010 and 2021, CVS submitted pharmacy claims to Medi-Cal using false electronic certifications that certified patients had medical conditions qualifying for pharmaceuticals under Medi-Cal.
CVS knowingly failed to verify or document compliance for nuerous claims, resulting in the payment of millions of dollars of false claims by Medi-Cal, according to Bonta’s office.
The allegations resolved by this settlement were raised under the whistleblower provisions of the False Claims Act by a former CVS pharmacist. The act enables citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. The whistleblower alleged that CVS submitted billing codes without doing the necessary verification and documentation.
Medi-Cal is funded jointly by the state and federal governments, so the United States will receive 44% of the settlement proceeds. The claims resolved by the settlement are allegations, and there has been no determination of liability.
Topics California Claims
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