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CVS unit ordered to pay $95 million in Medicare whistleblower lawsuit
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CVS unit ordered to pay $95 million in Medicare whistleblower lawsuit
Jun 26, 2025 2:15 PM

June 26 (Reuters) - CVS Health's ( CVS ) pharmacy

benefit manager unit must pay the U.S. government $95 million

after a federal judge found it overcharged Medicare for

prescription drugs.

Chief Judge Mitchell Goldberg in Philadelphia ordered the

payment by CVS Caremark on Wednesday, following an eight-day

non-jury trial in March in the whistleblower case.

Goldberg will decide after further briefing whether to

triple the award to $285 million under the federal False Claims

Act.

The case was brought in 2014 by Sarah Behnke, a former head

actuary for Medicare Part D at Aetna.

Behnke accused CVS Caremark of having since 2010 caused

health insurers, such as Aetna, to submit inflated claims to the

Centers for Medicare and Medicaid Services (CMS), while

pharmacies such as Rite Aid and Walgreens were paid

less.

CVS bought Aetna in 2018.

Despite ruling for CVS Caremark on some claims, Goldberg

concluded in a 105-page decision that the unit knew it was

managing drug prices in a manner that boosted margins, and

therefore profit.

"Although it is true that Aetna had the ultimate

responsibility to submit the claims, I disagree that this

responsibility absolves Caremark of culpability," Goldberg

wrote.

CVS, based in Woonsocket, Rhode Island, said on Thursday it

was disappointed in the rulings against CVS Caremark.

The False Claims Act lets whistleblowers sue on behalf of

the government and share in recoveries, typically 15% to 30%.

Though not directly involved in Behnke's case, the federal

government said in an October 2023 court filing it had a strong

interest in ensuring that Medicare Part D did not pay inflated

drug prices, and information reported by plan sponsors and

pharmacy benefit managers to CMS reflects the true costs.

The case is US ex rel Behnke v CVS Caremark Corp et al, U.S.

District Court, Eastern District of Pennsylvania, No. 14-00824.

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