AG James and Bipartisan Coalition of Attorneys General Found CVS Overbilled Medicaid for Insulin Prescriptions by Millions of Dollars
New York Attorney General Letitia James joined a bipartisan coalition of 36 other attorneys general and the United States Department of Justice (DOJ) in securing $36.5 million from CVS Pharmacy, Inc. (CVS) for fraudulently overbilling Medicaid for insulin prescriptions. From 2010 to 2020, CVS knowingly dispensed more insulin to customers than they needed while maintaining that they were reporting the correct amount of insulin in their prescriptions. These fraudulent claims allowed the company to rake in millions in extra reimbursements from Medicaid for insulin distribution. Under a settlement with Attorney General James and the coalition, CVS will pay more than $25 million to state Medicaid programs across the country, including $2.25 million to New York.
“When big companies defraud Medicaid, hardworking New Yorkers pay the price,” said Attorney General James. “Our state’s Medicaid funds should support health care for those in need, not unjustly boost the profits of big corporations like CVS. My office is focused on stopping fraud in all its forms, and I will continue to root out corporate corruption on behalf of New Yorkers.”
Insulin “pens” – a set dose of insulin in a syringe contained inside a plastic shell – are a common way for diabetic patients to give themselves the insulin they need. Patients need a prescription for these pens and receive a supply from their pharmacy that will last them a certain amount of time – often 30 or 90 days – along with instructions on how to administer the correct dose at the right frequency.
Attorney General James and the coalition’s investigation found that CVS dispensed more insulin to Medicaid recipients than their prescriptions specified and refilled insulin pen prescriptions well before they were needed. This allowed CVS to overbill Medicaid millions of dollars for more insulin than it should have been dispensing. To cover up their fraud, CVS falsely under-reported the amount of time that the supply of insulin would last and failed to comply with certain rules used to calculate refill dates. As a result of CVS’s false claims, some Medicaid recipients accumulated large quantities of unused insulin, which was both wasteful and potentially dangerous as insulin can expire.
As a result of the settlement, CVS will pay $36,500,000 to the states and federal government, including $25,108,480.45 for Medicaid programs in the participating states, and $2,257,250.51 for New York.
Joining Attorney General James in securing the settlement are the attorneys general of Arizona, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Washington, West Virginia, Wisconsin, and the District of Columbia.
A National Association of Medicaid Fraud Control Units (NAMFCU) team investigated the allegations in conjunction with the United States Attorney’s Office for the Southern District of New York. The NAMFCU team included attorney representatives from the offices of the attorneys general for the states of New York, California, Florida, and Wisconsin.
This matter was handled for New York by Assistant Attorney General Jill D. Brenner, under the supervision of Deputy Chief of Civil Enforcement Diana Elkind and Chief of Civil Enforcement Alee N. Scott, and Principal Auditor Investigator Meghan Collins under the supervision of Civil Enforcement Chief Auditor Stacey Millis. Investigative support was provided by Computer Program Analyst Nicholas Furnari. New York’s Medicaid Fraud Control Unit (MFCU) is led by Director Amy Held. MFCU is part of the Division for Criminal Justice, which is led by Chief Deputy Attorney General José Maldonado and overseen by First Deputy Attorney General Jennifer Levy.
New York MFCU’s total funding for federal fiscal year (FY) 2026 is $70,793,651. Of that total, 75 percent, or $53,095,240, is awarded under a grant from the U.S. Department of Health and Human Services. The remaining 25 percent, totaling $17,698,411 for FY 2026, is funded by New York State.
