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CVS to Pay $18.2 Million to Resolve Alleged False Medi‑Cal Pharmacy Claims

The United States receives 44.34% of the recovery under Medi‑Cal’s joint funding.

Overview

  • California Attorney General Rob Bonta announced the civil settlement with the U.S. Department of Justice resolving allegations tied to 2010–2021 billing.
  • Prosecutors say CVS used false electronic certifications and failed to verify required diagnoses and documentation for certain prescriptions, including some Code 1 drugs.
  • CVS admitted no liability and characterized the agreement as a way to avoid costly litigation, and the settlement makes no determination of wrongdoing.
  • A former CVS pharmacist brought the case under the False Claims Act and is slated to receive roughly $3.3 million from the recovery.
  • Settlement funds total $18,282,280.08, with more than $10.7 million designated as restitution and distributions to California and the United States.