On June 25, 2025, Chief Judge Mitchell S. Goldberg of the U.S. District Court for the Eastern District of Pennsylvania issued a ruling in the case of U.S. ex rel. Sarah Behnke v. CVS Caremark Corp. et al., ordering CVS Caremark to pay the U.S. government $95 million. Relator Sarah Behnke brought a qui tam action in February 2014 under the False Claims Act against CVS Caremark Corporation and related entities. The relator alleged that Caremark caused certain health insurers to misrepresent to the government the amount they paid for prescription drugs on behalf of Medicare beneficiaries. The relator claimed that Caremark, a pharmacy benefits manager (PBM), contracted with pharmacies to pay a fixed average price for prescription drugs to pharmacies but caused higher prices to be reported by insurers. The ruling followed an eight-day bench trial in March 2025 that took place after the court ruled on the parties’ cross motions for summary judgment.
The court ruled that CVS Caremark violated the FCA by knowingly causing health insurers, such as Aetna, to submit claims for prescription drugs at inflated prices to Medicare Part D. Caremark was found to have reported higher maximum allowable cost prices to insurers which were then submitted to CMS while paying discounted average prices to pharmacies like Walgreens and Rite Aid, which “resulted in the overpayment of tens of millions of dollars.” Behnke, 2:14-cv-00824-MSG, at 57. The court determined that the relator satisfied her...
Two-and-a-half weeks ago, lawyers for Department of Justice whistleblower Erez Reuveni presented his charges against Third Circuit nominee and other senior DOJ officials in a 27-page letter. I summ...