Now, a federal judge has confirmed that CVS Caremark, one of the largest pharmacy benefit managers (PBMs) in America, systematically lied to Medicare, overcharging the program by nearly $100 million. And this week, they were finally held accountable.

U.S. District Judge Mitchell S. Goldberg ordered CVS Caremark to pay $285 million in tripled damages, plus an additional $4.87 million in civil penalties, after the company was found liable for submitting false drug pricing reports to Medicare Part D. The ruling stems from a 2014 whistleblower lawsuit filed by Sarah Behnke, a former Aetna actuary who exposed how CVS manipulated drug costs to hide profits, costing taxpayers millions.

This isn't just corporate greed; it's fraud on a massive scale, and it proves once again that the pharmaceutical industry cannot be trusted to police itself.

A decade-long scheme to deceive Medicare

The fraud was simple but devastating. According to court documents, CVS Caremark anticipated a 2010 rule change that would cut into its profits from Medicare Part D drug reimbursements. Instead of accepting lower margins, the company devised a hidden profit scheme, submitting false drug cost reports to the Centers for Medicare and Medicaid Services (CMS).

Judge Goldberg found that CVS knowingly misled CMS for years, causing the agency to over-subsidize prescription drug costs by approximately $95 million. Even when questioned by regulators, CVS concealed the truth, breaking the public's trust in a program meant to help vulnerable seniors.

"Caremark's actions cost CMS close to $100 million and made the administration of Medicare Part D—a program aimed at lowering drug costs for a vulnerable population—more difficult," Goldberg wrote in his ruling.