On October 13, 2026, the Department of Justice announced that CVS Pharmacy Inc. and related entities agreed to pay $315 million to resolve allegations that they unlawfully filled prescriptions for opioids and other controlled substances and then sought payment for many of those prescriptions from Medicare and other federal healthcare programs. The resolution consists of $189 million, plus interest, under the False Claims Act (FCA) settlement agreement and $126 million under a separate Controlled Substances Act (CSA) agreement.
The government alleged that CVS knowingly filled controlled-substance prescriptions that were invalid, medically unnecessary, not issued for a legitimate medical purpose or in the usual course of professional practice, presented unresolved or undocumented red flags, or violated refill restrictions. According to the government’s complaint, the prescriptions included dangerous or excessive opioid quantities, prescriptions filled too early, and so-called “trinity” combinations of an opioid, a benzodiazepine, and a muscle relaxant. CVS also allegedly filled prescriptions from pill-mill prescribers despite red flags indicating a high likelihood that the prescriptions were not valid or medically appropriate.
The government’s theory extended beyond individual dispensing decisions. The complaint alleged that CVS imposed performance metrics, incentive compensation, and staffing policies that prioritized corporate performance over patient safety and compliance. It further alleged that CVS did not employ enough pharmacists to serve patients, satisfy legal obligations, and meet corporate metrics, and that company policies prevented pharmacists from warning one another about certain problematic prescribers. The civil action began with a qui tam complaint filed by a former CVS employee.
CVS also entered into a DEA memorandum of agreement that runs through August 15, 2032. Among other measures, CVS must maintain controlled-substance oversight and compliance functions, provide annual compliance certifications and dispensing data to the DEA, establish a hotline for employees and the public to report suspected unlawful dispensing, proactively monitor pharmacy dispensing patterns, and maintain a process for evaluating prescribers suspected of illegal prescribing.
GWB represents healthcare providers in connection with government investigations, including those involving the DEA’s Office of Diversion Control, and False Claims Act litigation. If you need assistance with such a matter, contact us today.
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