Hawaiʻi will receive $617,160 from a national CVS Pharmacy settlement resolving civil allegations that the company submitted false claims tied to insulin pen refills and dispensing practices.
The settlement includes the United States, the District of Columbia, and 35 states, according to Maui Now and the Hawaiʻi Department of the Attorney General.
Hawaiʻi Attorney General Anne Lopez said the recovery came through the state’s Medicaid Fraud Control Unit, working with other state Medicaid fraud units, the U.S. Department of Justice, and federal partners.
The settlement resolves civil allegations. It is not a criminal conviction, and the agreement covers claims involving CVS’s billing and dispensing practices from 2010 through 2020.
The Case Centered on Insulin Pen Refills
The allegations involved insulin pens dispensed to patients enrolled in government healthcare programs, including Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program.
Authorities alleged that CVS requested and received reimbursement for premature refills. The settlement also resolved claims that CVS dispensed more insulin pens than patients needed under their prescriptions.
The Hawaiʻi attorney general’s office said CVS also falsely under-reported the days-of-supply for insulin pens dispensed by its pharmacies. That alleged reporting problem affected when refills appeared eligible for payment.
CVS Accepted Responsibility for Certain Conduct
As part of the settlement, CVS admitted and accepted responsibility for certain conduct, according to Hawaiʻi’s attorney general.
The company acknowledged that government healthcare programs paid substantial amounts for insulin pen refills that were ineligible for reimbursement.
CVS also accepted that its pharmacies dispensed more insulin pens to government healthcare beneficiaries than those patients needed.
The Settlement Came From Five Whistleblower Cases
The settlement resolves allegations raised in five federal qui tam actions. Those cases alleged false claims under the federal False Claims Act and state false claims laws.
The investigation was handled by a National Association of Medicaid Fraud Control Units team in coordination with the U.S. Attorney’s Office for the Southern District of New York and federal law enforcement partners.
Attorney representatives from California, Florida, New York, and Wisconsin participated on the national team. Hawaiʻi’s share of the recovery is $617,160.
Patients Can Check Refill Records Against What They Actually Received
The practical check for patients is the refill history, not only the receipt from the pharmacy counter. Anyone using insulin pens can compare the prescription label, days’ supply, refill date, and number of pens dispensed against their insurance explanation of benefits, Medicare Summary Notice, Medicaid account record, pharmacy app, or online prescription history.
A refill that appears earlier than expected, a days’ supply that does not match how the prescription is used, or a claim for more pens than the patient received should be questioned with the pharmacy, prescriber, and health plan.
Suspected Medicare fraud can be reported to the U.S. Department of Health and Human Services Office of Inspector General at OIG.HHS.gov or 1-800-447-8477. Hawaiʻi Medicaid fraud can also be reported to the Hawaiʻi Medicaid Fraud Control Unit, which investigates provider fraud against the Medicaid program.