CVS Health's Aetna Agrees to Pay $117.7M to Settle False Claims Allegations
Written by Emily J. Thompson, Senior Investment Analyst
Updated: 21 hours ago
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Should l Buy CVS?
CVS Health's Aetna agreed to pay $117.7M to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees in order to increase its payments from Medicare, the Justice Department said in a statement. The U.S. alleges that Aetna "submitted inaccurate and untruthful patient diagnosis data to CMS in order to inflate the risk adjustment payments it received from CMS, failed to withdraw the inaccurate and untruthful diagnosis data and repay CMS, and falsely certified in writing to CMS that the data was accurate and truthful."
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Analyst Views on CVS
Wall Street analysts forecast CVS stock price to rise
17 Analyst Rating
16 Buy
1 Hold
0 Sell
Strong Buy
Current: 76.320
Low
91.00
Averages
96.71
High
105.00
Current: 76.320
Low
91.00
Averages
96.71
High
105.00
About CVS
CVS Health Corporation is a health solutions company. The Company's segments include Health Care Benefits, Health Services, Pharmacy & Consumer Wellness and Corporate/Other. Health Care Benefits segment offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental and behavioral health plans, PDPs and Medicaid health care management services. Health Services segment provides a full range of pharmacy benefit management (PBM) solutions through its CVS Caremark operations and delivers health care services in its medical clinics, virtually, and in the home. Pharmacy & Consumer Wellness segment dispenses prescriptions in its CVS Pharmacy retail locations and through its infusion operations, provides ancillary pharmacy services including pharmacy patient care programs, diagnostic testing and vaccination administration, and sells a wide assortment of health and wellness products and general merchandise.
About the author
Emily J. Thompson
Emily J. Thompson, a Chartered Financial Analyst (CFA) with 12 years in investment research, graduated with honors from the Wharton School. Specializing in industrial and technology stocks, she provides in-depth analysis for Intellectia’s earnings and market brief reports.
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- Background of Allegations: The Department of Justice accused CVS of submitting inaccurate patient diagnosis data in the Medicare Advantage program to secure higher risk adjustment payments, undermining the integrity of Medicare and potentially subjecting the company to stricter regulatory scrutiny.
- Government Statement: Acting Deputy Inspector General Scott Lampert emphasized that any company attempting to exploit Medicare Advantage will be held accountable, indicating a zero-tolerance policy towards Medicare fraud that could serve as a warning to others in the industry.
- Future Implications: This settlement may lead to increased compliance costs and a potential crisis of trust in the market for CVS, particularly in the Medicare sector, prompting investors to monitor its impact on the company's long-term profitability.
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- CVS Health's Market Position: With over 9,000 locations across the U.S., CVS Health's diversified healthcare services, including pharmacy, primary care, and health insurance, are expected to maintain stable earnings during a recession, boasting a market cap of $97 billion.
- Dividend Appeal: CVS Health offers a dividend yield of 3.4%, significantly higher than the S&P 500's 1.2%, and has increased its dividend by 56.5% over the past decade, highlighting its attractiveness amid economic uncertainty.
- Gilead Sciences' Product Portfolio: Known for its leading HIV medications, including Biktarvy and Descovy, Gilead Sciences is expected to see continued demand for its key products even during economic downturns, with a market cap of $184 billion.
- Robust Dividend Policy: Gilead Sciences has a forward dividend yield exceeding 2.3% and has increased its payouts by 90.7% over the past decade, making it a solid anchor in a diversified portfolio during tough economic times.
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