CVS reaches settlement to pay $315M in opioid prescriptions case

US Attorney Ken Sorenson announced that CVS Pharmacy Inc. chain, and its related corporate entities have agreed to pay $315 million to resolve allegations in an opioid prescriptions and claims case.

The complaint alleges that, from Oct. 17, 2013 through Dec. 2, 2025, CVS illegally filled prescriptions for opioids and other controlled substances in violation of the Controlled Substances Act, and then sought payment for many of those invalid prescriptions from Medicare and other federal healthcare programs in violation of the False Claims Act, according to the US Department of Justice.

“This litigation and resulting settlement demonstrate our solemn commitment to protect patients in our community and the integrity of our federal healthcare programs. We all suffer and pay the cost when large scale fraud infects the claim and payment process as happened here,” said United States Attorney Ken Sorenson. “The DEA’s Office of Diversion Control, Los Angeles Field Division played a key role in our investigation, and we will continue our efforts to investigate and fight healthcare fraud with our federal and state partners.”

“The opioid epidemic has affected families and communities across Rhode Island and throughout the nation,” said First Assistant US Attorney Charles C. Calenda for the District of Rhode Island. “Pharmacies that dispense controlled substances must maintain effective compliance systems to identify and respond to warning signs that prescriptions may be unlawful or medically unnecessary. This settlement demonstrates the importance of those obligations and the consequences of failing to implement safeguards designed to prevent the improper dispensing of controlled substances.”

The settlement resolves allegations in the government’s complaint, which the United States filed on Dec. 13, 2024, in the US District Court for the District of Rhode Island, that CVS knowingly filled prescriptions for controlled substances that lacked a legitimate medical purpose, were not valid, and/or were not issued in the usual course of professional practice.

The United States alleged that CVS dispensed prescriptions for dangerous and excessive quantities of opioids, opioid prescriptions filled too early, and “trinity” prescriptions, a dangerous and abused combination of an opioid, a benzodiazepine, and a muscle relaxant.

CVS also allegedly filled prescriptions for controlled substances from “pill mill” prescribers who issued large numbers of controlled substance prescriptions without any medical purpose, according to the allegations.

Further, the United States alleged that CVS pharmacists filled these prescriptions despite clear red flags indicating that there was a high likelihood that the prescriptions lacked a legitimate medical purpose, were not valid, or were not issued in the course of professional practice. Many of these prescriptions were ultimately billed to and reimbursed by federal healthcare programs, according to the Department of Justice.

The complaint further alleged that CVS’s violations stemmed from corporate-imposed performance metrics, incentive compensation, and staffing policies that prioritized corporate profits over patient safety. CVS failed to employ enough pharmacists to serve patients, comply with CVS’s legal obligations, and meet corporate performance metrics. In addition, CVS’s policies allegedly prevented pharmacists from warning one another about certain problematic prescribers.

In addition to the monetary payment announced today, CVS has entered into a memorandum of agreement with DEA to address its future obligations in dispensing controlled substances. This agreement requires CVS to establish a hotline for both employees and the public to report suspected illegal dispensing of controlled substances, proactively monitor the dispensing patterns of its pharmacies to identify and address potentially illegal dispensing, and establish a process to evaluate prescribers suspected of illegal prescribing.

The civil settlement resolves a civil lawsuit filed by Hillary Estright, a former CVS employee, under the whistleblower provision of the FCA, which authorizes private parties to sue on behalf of the United States and receive a share of any recovery. It also permits the United States to intervene and take over such lawsuits, as it did here. The amount to be recovered by the private whistleblower has not yet been determined. The qui tam case is captioned United States ex rel. Hillary Estright v. CVS Health Corporation, et al., No. 22-cv-00222 (D.R.I.).

The claims resolved by the settlement are allegations only, and there has been no determination of liability.