Justice Department Files Civil Complaint Against CVS Pharmacy Alleging Unlawful Prescription Practices and Healthcare Fraud
The U.S. Department of Justice has filed a civil complaint in Providence, Rhode Island, against CVS Pharmacy Inc. and its subsidiaries, alleging violations of the Controlled Substances Act (CSA) and the False Claims Act (FCA). The complaint accuses CVS, the largest pharmacy chain in the United States with over 9,000 locations, of filling unlawful prescriptions and seeking federal reimbursements for these prescriptions.
Allegations of Unlawful Practices
The complaint claims that from October 17, 2013, to the present, CVS knowingly filled prescriptions for controlled substances without legitimate medical purposes. These prescriptions allegedly included excessive quantities of opioids, early refills, and combinations known as the "trinity"—a dangerous mix of opioids, benzodiazepines, and muscle relaxants often abused by patients. CVS is also accused of filling prescriptions issued by “pill mill” prescribers—healthcare providers who routinely dispense controlled substances without proper medical justification.
According to the government, CVS ignored substantial evidence, including warnings from its own pharmacists and internal data, indicating these prescriptions were unlawful. The complaint alleges that corporate policies emphasizing performance metrics, incentive compensation, and inadequate staffing contributed to these practices. CVS allegedly deprived pharmacists of critical information, making it difficult to identify problematic prescribers and prescriptions.
Impact on the Opioid Crisis
The Justice Department argues that CVS’s actions fueled the ongoing opioid epidemic, which has devastated communities across the nation. In some instances, patients died of overdoses shortly after filling unlawful prescriptions at CVS pharmacies.
"CVS repeatedly filled controlled substance prescriptions that were unlawful, pressuring pharmacists to do so without proper verification,” said Principal Deputy Assistant Attorney General Brian M. Boynton. “These practices contributed to the opioid crisis and opioid-related deaths. Today’s complaint seeks to hold CVS accountable.”
Government’s Legal Action
The complaint seeks civil penalties for each unlawful prescription filled in violation of the CSA and treble damages under the FCA for prescriptions reimbursed by federal healthcare programs. The court may also impose injunctive relief requiring CVS to implement stricter compliance measures.
“The dispensing of opioids is governed by clear laws that apply to everyone, from individuals to major corporations,” said U.S. Attorney Jessica D. Aber for the Eastern District of Virginia. “We will take legal action against any entity that prioritizes profits over public safety.”
Investigative Findings
The investigation was conducted by multiple federal agencies, including the Drug Enforcement Administration (DEA), the Department of Health and Human Services Office of Inspector General (HHS-OIG), and the Defense Criminal Investigative Service (DCIS). Findings revealed CVS dispensed large amounts of addictive opioids to individuals without legitimate medical need, neglecting its role as a gatekeeper in the pharmaceutical distribution process.
“Pharmacies are critical partners in ensuring controlled substances are dispensed lawfully and safely,” said Deputy Inspector General Christian J. Schrank of HHS-OIG. “When they fail to meet these responsibilities, we will hold them accountable.”
Whistleblower’s Role
The lawsuit originated from a 2019 whistleblower complaint filed under the FCA’s qui tam provisions, which allow private citizens to sue on behalf of the government and share in any financial recovery. Whistleblower Hillary Estright, a former CVS employee, brought the allegations to light.
Broader Commitment to Combat Fraud
This case highlights the government’s dedication to addressing healthcare fraud and holding corporations accountable. The Department of Justice encourages individuals to report potential fraud, waste, and abuse through the Department of Health and Human Services’ tip line.
Ongoing Litigation
The case, United States ex rel. Estright v. Health Corporation, et al., is pending in the District of Rhode Island. The Justice Department emphasized that all claims are allegations at this stage, and liability has not yet been determined.
Source: Office of Public Affairs