CVS Settles Fraud Allegations with the US, Multiple States & Cities
Post 5246
Read the full article at https://lnkd.in/gWPTErTV, see the video at https://lnkd.in/gcmb4USM and at https://lnkd.in/gZcEHcZ9, and at https://zalma.com/blog plus more than 5200 posts.
False Claims Act Claims Resolved by CVS
In United States Of America v. CVS Pharmacy, Inc. et al, Nos. 18 Civ. 3047 (JGK), 19 Civ. 1550 (JGK), 19 Civ. 8454 (JGK), 19 Civ. 11244 (JGK), 20 Civ. 2173 (JGK), 18 Civ. 3047 (JGK), United States District Court, S.D. New York (December 1, 2025) Honolable John G. Koeltl United States District Judge concluded that Relators filed the above-captioned multiple actions against defendant CVS Pharmacy, Inc. (“CVS”) and other entities on behalf of the United States under the qui tam provisions of the False Claims Act, 31 U.S.C. § 3729 et seq., on behalf of 30 states, the District of Columbia, Puerto Rico, and the Virgin Islands under comparable state false claims and insurance fraud laws, and on behalf of six municipalities under comparable municipal false claims laws, which were designated as “related” pursuant to the Local Rules of this Court (collectively, the “Actions”).
Under the settlement approved by the court CVS agreed to pay a total sum of $37.76 million, with $24,446,240 to be paid to the United States and the remainder to be paid to various states. As part of the settlement, CVS also admitted and accepted responsibility for certain conduct alleged by the Government in its complaint, including that GHPs paid CVS substantial amounts for insulin pen refills that were ineligible for reimbursement and CVS pharmacies dispensed more insulin to GHP beneficiaries than they needed.
The US Attorney noted that “CVS engaged in a decade-long practice of repeatedly prematurely refilling insulin prescriptions for patients and improperly billing government healthcare programs for more insulin than patients needed… These programs rely on pharmacies to follow appropriate refill schedules and to accurately report the amount of medicine dispensed, which CVS pharmacies frequently failed to do.”
The USDC concluded that on or about May 5, 2025, the Plaintiff States, with the exception of the California Department of Insurance, filed a Notice of Decision to Decline Intervention, notifying the Court of their decisions to decline intervention in these Actions (the “State Notice of Declination”).
On or about October 1, 2025, relator RJA, LLP, filed a notice voluntarily dismissing without prejudice claims it asserted on behalf of five Plaintiff Municipalities (the “RJA Notice of Municipal Claims Dismissal”), and on or about October 15, 2025, the Court issued an Order granting RJA, LLP’s motion to voluntarily dismiss without prejudice claims it asserted on behalf of the City of Chicago (the “RJA Chicago Claims Dismissal Order”).
The United States filed a Complaint-in-Intervention (the “Government Complaint”) against CVS; and the United States, CVS, and Relators have entered into a Stipulation and Order of Settlement and Dismissal (the “Settlement”);
Since the United States and Relators have entered into a Stipulation and Order of Settlement and Release Between the United States and Relators (the “Relator Stipulation”) it was ordered that:
The seals were lifted as to the Government Notice of Partial Intervention, the State Notice of Declination, the RJA Notice of Municipal Claims Dismissal, the RJA Chicago Claims Dismissal Order, the Government Complaint, the Settlement, the Relator Stipulation, and the complaints and any amended complaints filed by Relators in these Actions and the settlement was approved.
ZALMA OPINION
Multiple CVS entities across the country were sued by “Relators” in a Qui Tam suit that was joined by the US Government, several states and cities for violation of the False Claims Act. The various parties agreed with the CVS entities and pharmacies and presented the agreement to the court which decided to approve the settlement and provide the US Treasury and state and city treasuries with funds they did not have.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution
Post 5489
Posted on September 14, 2026 by Barry Zalma
Fraudster Refuses to Answer Questions About His Alleged Fraud
See the full video at https://lnkd.in/gvicAMDr and at https://lnkd.in/gvicAMDr
In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.
Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.
After Great American ...
Policy Limits Demand Accepted Settles Claim
Post 5434
Posted on August 26, 2026 by Barry Zalma
See the full video at https://lnkd.in/g-ZtsSgK and at https://lnkd.in/ghMBdYWR
A Contingent Offer Accepted Ends the Dispute
In Farmers Insurance Exchange, a California Reciprocal Insurance Exchange, The Superior Court For The County Of San Bernardino, Kathleen Ann Wood, E087128, California Court of Appeals, (July 9, 2026) Farmers Insurance Exchange insured Doyle Archer under an automobile policy with bodily injury limits of $15,000 per person and $30,000 per accident.
FACTUAL BACKGROUND
Archer rear-ended Kathleen Ann Wood at a red light, causing Wood to assert a bodily injury claim against him. Wood’s counsel sent Farmers a pre-litigation settlement demand offering to resolve Wood’s claim for the available policy limits, stating that if the $100,000 demand exceeded the policy, the offer was for the policy limits.
Farmers timely responded in writing, agreed to pay Wood the $15,000 per-person policy limit, and provided the requested ...
Policy Limits Demand Accepted Settles Claim
Post 5434
Posted on August 26, 2026 by Barry Zalma
See the full video at https://lnkd.in/g-ZtsSgK and at https://lnkd.in/ghMBdYWR
A Contingent Offer Accepted Ends the Dispute
In Farmers Insurance Exchange, a California Reciprocal Insurance Exchange, The Superior Court For The County Of San Bernardino, Kathleen Ann Wood, E087128, California Court of Appeals, (July 9, 2026) Farmers Insurance Exchange insured Doyle Archer under an automobile policy with bodily injury limits of $15,000 per person and $30,000 per accident.
FACTUAL BACKGROUND
Archer rear-ended Kathleen Ann Wood at a red light, causing Wood to assert a bodily injury claim against him. Wood’s counsel sent Farmers a pre-litigation settlement demand offering to resolve Wood’s claim for the available policy limits, stating that if the $100,000 demand exceeded the policy, the offer was for the policy limits.
Farmers timely responded in writing, agreed to pay Wood the $15,000 per-person policy limit, and provided the requested ...
Communications with Arson Investigation is Privileged
Post 5488
Posted on September 11, 2026 by Barry Zalma
ACE Was Not Required To Produce Any Disputed Document Because Each Was Protected By The Attorney-Client Privilege, or The Work-Product Doctrine.
See the full video at and at https://rumble.com/v7fbzvo-arson-for-profit-is-ground-to-deny-claim.html
In Rubesne Resources LLC, a Colorado Limited Liability Company v. ACE Property And Casualty Insurance Company, a Foreign Corporation, Civil Action No. 1:24-cv-02300-DDD-SBP, United States District Court, D. Colorado (August 30, 2026) Rubesne Resources LLC sought insurance coverage from ACE Property and Casualty Company after a January 5, 2024 fire destroyed its business.
South Metro Fire Rescue classified the ignition as intentional, and ACE’s retained expert concluded that gasoline had been poured in multiple areas and ignited. ACE retained coverage and subrogation counsel, National Subrogation Services, and a cause-and-origin expert ...
Arson for Profit is Ground to Deny Claim
Posted on September 11, 2026 by Barry Zalma
Communications with Arson Investigation is Privileged
Post 5488
ACE Was Not Required To Produce Any Disputed Document Because Each Was Protected By The Attorney-Client Privilege, or The Work-Product Doctrine.
See the full video at and at https://rumble.com/v7fbzvo-arson-for-profit-is-ground-to-deny-claim.html
In Rubesne Resources LLC, a Colorado Limited Liability Company v. ACE Property And Casualty Insurance Company, a Foreign Corporation, Civil Action No. 1:24-cv-02300-DDD-SBP, United States District Court, D. Colorado (August 30, 2026) Rubesne Resources LLC sought insurance coverage from ACE Property and Casualty Company after a January 5, 2024 fire destroyed its business.
South Metro Fire Rescue classified the ignition as intentional.
After reviewing the disputed documents in camera, the court found that each was protected.
LAW
Colorado Revised Statutes § 10-4-1003 requires ...
Referral of Claims to its SIU Is Not Bad Faith
Post 5487
Posted on September 10, 2026 by Barry Zalma
In WIZ Collision, LLC, on behalf of itself and as assignee of Jawara Small, Chester Street LLC, and Aziz Brooks v. GEICO Corporation, No. 25-cv-4201 (KAM)(JAM), United States District Court, E.D. New York (August 28, 2026) Wiz Collision, a New York City auto-body shop, regularly repaired vehicles and submitted insurance claims for customers. It alleged that GEICO repeatedly approved claims and repairs, then referred certain claims to its Special Investigations Unit, stopped issuing payments, and delayed resolution despite ultimately finding no fraud.
Wiz Collision sued on its own behalf and as purported assignee of three customers, asserting contract, good-faith, consumer-protection, and injunctive claims. GEICO removed the case and moved to dismiss under Rule 12(b)(6).
LAW
Under Rule 12(b)(6), a complaint must plead facts supporting a facially plausible claim. Article III standing requires a concrete injury, ...
