News Briefs: CVS Caremark Must Pay Gov’t $95M in Medicare Overbilling Case

Jun 26
Jun 26, 2025

A federal judge on June 25 ordered CVS Health Corp.’s Caremark to pay the federal government $95 million after agreeing with a whistleblower’s claims that the PBM inflated Medicare Part D drug prices to offset higher costs in other lines of business. “The more Caremark paid pharmacies on Part D drugs, the less it had to pay on commercial drugs,” Judge Mitchell Goldberg U.S. District Court for the Eastern District of Pennsylvania wrote in an opinion. But the judge did not rule on claims that CVS Caremark knowingly concealed its conduct. Goldberg also ordered CVS and Sarah Behnke — the former Aetna executive who brought the suit — to submit briefs by July 9 on whether CVS Caremark’s conduct represented a reverse False Claims Act violation.
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Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.