The Justice Department has filed a civil lawsuit against CVS Pharmacy Inc. and its subsidiaries, alleging that the company filled unlawful prescriptions in violation of the Controlled Substances Act (CSA) and sought reimbursements from federal healthcare programs in breach of the False Claims Act (FCA). The complaint was unsealed in Providence, Rhode Island.
According to the government, CVS knowingly dispensed prescriptions for controlled substances without legitimate medical purposes from October 17, 2013, to present. These included excessive quantities of opioids and "trinity" prescriptions—a combination of an opioid, a benzodiazepine, and a muscle relaxant—along with prescriptions from prescribers involved in "pill mill practices." The complaint states that CVS ignored evidence indicating these unlawful activities.
The Justice Department claims that corporate policies at CVS prioritized profits over patient safety by enforcing performance metrics and staffing levels that compromised pharmacists' ability to meet legal obligations. As stated by Principal Deputy Assistant Attorney General Brian M. Boynton: “Our complaint alleges that CVS repeatedly filled controlled substance prescriptions that were unlawful... The practices alleged contributed to the opioid crisis and opioid-related deaths.”
U.S. Attorney Zachary A. Cunha remarked on the impact of opioid misuse: “Opioid deaths remain a scourge on communities across Rhode Island and the nation... This lawsuit alleges that CVS failed to exercise its critical role as gatekeeper of dangerous prescription opioids.” If found liable, CVS could face penalties for each unlawful prescription under CSA violations and treble damages for FCA breaches.
DEA Administrator Anne Milgram commented: “CVS is alleged to have dispensed large amounts of highly addictive opioid medications... Simply put, they put profits over their obligation to keep their customers safe.” The case highlights ongoing efforts by various government agencies to combat health care fraud using tools like the FCA.
Whistleblower Hillary Estright initiated this action under FCA's qui tam provisions in 2019. The U.S. government's intervention reflects its commitment to addressing health care fraud issues.
The investigation involved multiple agencies including DEA’s Office of Diversion Control, HHS-OIG, DCIS, among others. Various attorneys from different districts are handling litigation efforts.
It is important to note that these allegations have not yet been proven in court.