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.
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See the full video at https://lnkd.in/gWQQEySW and at https://lnkd.in/gyhdK6wv
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime.
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime.
After ...
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Post 5397
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The ...
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Post 5396
See the video and at https://rumble.com/v7ctgmq-the-great-jewel-theft.html at https://youtu.be/aRbQ2sJfGwA
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the ¬¬¬Perpetrators than any Other Crime.
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Day Care Owner Loses Subsidies Because She Criticized State
Post 5421
Posted on August 11, 2026 by Barry Zalma
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Rescission for Material Misrepresentation
Post 5418
Posted on August 5, 2026 by Barry Zalma
An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.
In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units. After an underlying personal injury action was filed, Union Mutual determined that the property actually contained three apartment units and rescinded the policies on the ground that the defendants had made a material misrepresentation in the applications.
LAW:
A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true ...
Rescission for Material Misrepresentation
Post 5418
Posted on August 5, 2026 by Barry Zalma
An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.
In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units.
LAW:
A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true facts been disclosed. To establish materiality as a matter of law, the insurer must submit documentation of its underwriting practices, such as manuals, guidelines, bulletins, or rules addressing similar risks.
DISCUSSION/ANALYSIS:
As a result, the...
