CVS to Pay 315 Million Dollars Over Claims It Billed Medicare for Unlawful Opioid Prescriptions

CVS Pharmacy Inc. and its affiliated entities agreed on October 13, 2026 to pay 315 million dollars to resolve federal allegations that the company illegally filled prescriptions for opioids and other controlled substances and then sought payment from Medicare and other federal healthcare programs, the Department of Justice announced.

The settlement covers conduct spanning from October 2013 through December 2025. According to the Justice Department, CVS dispensed prescriptions that lacked a legitimate medical purpose, including prescriptions written by providers suspected of operating pill mills, prescriptions for dangerous or excessive quantities of opioids, combination prescriptions pairing opioids with benzodiazepines and muscle relaxants, and refills dispensed before a patient would medically need them.

The government also alleged that corporate performance metrics, incentive pay structures, and pharmacist understaffing pressured employees to prioritize prescription volume over patient safety and legal compliance.

Under the terms of the settlement, CVS must establish a hotline for reporting suspected illegal dispensing, proactively monitor dispensing patterns across its pharmacy network, evaluate prescribers flagged for potentially unlawful activity, and apply additional safeguards to controlled substance prescriptions.

The agreement is structured under the False Claims Act, which allows the federal government to recover payments made when healthcare providers bill federal programs for services that were not medically legitimate. Medicare is among the programs covered by the resolution. CVS did not admit liability as part of the settlement.