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.