Attorney General Tong Joins Whistleblower Suit Against CVS Pharmacy for Overbilling Medicaid for Prescriptions

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05/08/2025

Attorney General Tong Joins Whistleblower Suit Against CVS Pharmacy for Overbilling Medicaid for Prescriptions

(Hartford, CT) -- Attorney General William Tong announced today that Connecticut has joined a whistleblower suit and filed a complaint in intervention against CVS Pharmacy, Inc. alleging the pharmacy fraudulently overbilled state Medicaid programs for prescription drugs dispensed at its retail pharmacies. Massachusetts, Indiana and Oklahoma have also joined as intervenors.

The Connecticut Medicaid program is a joint federal and state program that provides health coverage, including prescription drugs, to low-income individuals, families, children, pregnant women, the elderly, and people with disabilities in Connecticut.

The complaint centers around state regulations that ensure pharmacies and providers do not charge Medicaid more than they charge other customers for the same prescriptions and services. Starting around 2010, certain pharmacies began offering loyalty or discount programs to customers on a “membership” basis. These programs offer lower prices for customers who paid without insurance. In response, Connecticut updated its law to explicitly clarify that a pharmacy must bill Medicaid its lowest discount program price.

Connecticut alleges that CVS, starting in 2016, transitioned the administration of its discount program to a third-party vendor, and continued to bill Medicaid at the higher prices. An investigation conducted by the Connecticut Office of the Attorney General identified specific prescription drugs for which the state Medicaid program paid more than customers using discount cards were charged for those same drugs.

“Connecticut’s laws exist to ensure fair, transparent drug pricing in Medicaid. CVS knew those laws, and they did not comply. We are committed to protecting the integrity of our taxpayer-funded healthcare programs,” said Attorney General Tong.

The case is captioned United States et al. ex rel. Doe v. CVS Health Corporation et al., No. 1:16-cv-02359, in the U.S. District Court for the District of Columbia. The lawsuit was originally filed under the qui tam or whistleblower provisions of the state and federal False Claims Acts, which allow private parties to file suit on behalf of the government for false claims and to receive a share of any recovery. The act permits the government to intervene and take over responsibility for litigating these cases, as Connecticut has done here.

Assistant Attorneys General Eric Babbs and Christine Miller, Forensic Fraud Examiner Lisa Bailey and Gregory O’Connell, Chief of the Government Fraud Section are assisting the Attorney General in this matter.

Twitter: @AGWilliamTong

Facebook: CT Attorney General

Media Contact:

Elizabeth Benton
elizabeth.benton@ct.gov

Consumer Inquiries:

860-808-5318
attorney.general@ct.gov