A recent ruling out of New York is the latest notable step in a very long-running saga involving alleged healthcare fraud by Omnicare, a Pharmacy Benefit Manager (PBM) owned by CVS. The companies were ordered to pay about $949 million in a settlement.
The case was initially filed in 2015 (the same year CVS acquired Omnicare) by a whistleblower: an Omnicare pharmacist who worked primarily in New Mexico. The whistleblower filed her suit under the False Claims Act (FCA) and state equivalents. These are laws that allow private individuals to file suit in the name of the U.S. (or states) and allege that healthcare programs like TRICARE, Medicare, or Medicaid are being defrauded. Whistleblowers are eligible to share in 15-30 percent of any ultimate recovery.
The crux of the allegations in this case is that Omnicare dispensed drugs to individuals in various long-term residential facilities that were not supported by valid prescriptions under state law and charged Medicare, Medicaid, and TRICARE for those drugs. The allegations touch patients in more than 3,000 facilities. Allegedly, the prescriptions were automatically assigned new prescription numbers, refills were automatically authorized, and prescriptions were periodically refilled in bulk without confirming that the prescriptions were still medically necessary or authorized by a physician.
CVS, as Omnicare’s parent company, was accused of “causing” the false claims to be submitted, as it was aware of deficiencies in Omnicare’s practices, but failed to correct them.
The federal government and 29 states joined the case in 2019, and it went to trial this Spring, in New York. After the trial, the jury unanimously found about $135 million in damages and held both companies, Omnicare and CVS, liable for the conduct. This was one of the largest-ever jury verdicts under the FCA.
In July, the Judge trebled (tripled) damages, which is required under the law, upping the damages figure to nearly $500 million. In the same ruling, the Judge also imposed penalties, which the law allows to attach to every false claim. The penalty amount was roughly another $500 million, with CVS Omnicare being held to have liabilities of $949 million. Additional motions are pending, including requests by Omnicare to toss the jury’s verdict and by CVS to be removed from the case. After those are decided, an appeal to the Second Circuit Court of Appeals is possible. Last month’s ruling is an important milestone, but this legal battle is likely far from over.
When Medicare introduced the Prospective Payment System (PPS) in the 1980s, it was billed as a revolution. Hospitals would be paid the same flat amount
Last week, Gainesville, Florida-based medical device company Exactech Inc. agreed to pay $8 million to resolve allegations that it violated the False Claims Act (FCA)
Please log in to your account to comment on this article.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.
Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
