Major healthcare settlements reached record levels in 2025, with the U.S. Department of Justice recovering more than $5.7 billion in healthcare fraud cases alone. The biggest resolutions included a $948.8 million judgment against CVS subsidiary Omnicare, a $556 million Medicare Advantage settlement with Kaiser Permanente, and a $450 million kickback and price-fixing deal with Teva Pharmaceuticals. Alongside these federal cases, state attorneys general, antitrust plaintiffs, and data breach classes drove hundreds of millions more in recoveries from insurers, hospital systems, and billing contractors.
CVS and Omnicare: $948.8 Million Judgment Plus Follow-On Settlements
In April 2025, a federal jury in the Southern District of New York found CVS subsidiary Omnicare liable under the False Claims Act for billing Medicare, Medicaid, and TRICARE for drugs dispensed on invalid prescriptions to elderly and disabled residents of assisted living and long-term care facilities between 2010 and 2018. The scheme involved filling “stale” prescriptions that had expired or were otherwise no longer valid. Judge Colleen McMahon ordered Omnicare to pay $948.8 million, combining roughly $407 million in trebled damages with $542 million in statutory penalties for more than 3.3 million false claims. CVS itself was held jointly liable for $164.8 million of the penalty for failing to stop the practice after acquiring Omnicare in 2015.1McKnight’s Senior Living. Omnicare Must Pay $949 Million in Damages, Penalties in False Claims Act Case, Judge Orders CVS denied wrongdoing and announced it would appeal, arguing the practices were “limited to Omnicare” and “accepted by CMS.”2Bloomberg Tax. CVS, Omnicare Unable to Knock Out $949 Million Drug Fraud Ruling
That verdict was only part of CVS’s year. In December 2025, CVS Pharmacy agreed to pay $37.76 million to resolve allegations that it over-dispensed insulin pens and improperly billed government healthcare programs from 2010 through 2020. The DOJ said CVS dispensed more insulin than patients needed, under-reported days of supply to avoid claim rejections, and refilled prescriptions prematurely. The company admitted the conduct and acknowledged it had learned of the problem through periodic audits that produced chargebacks, yet left the practice uncorrected for a decade.3U.S. Department of Justice. U.S. Attorney Announces $37.76 Million Settlement With CVS Over Dispensing Insulin Pens
A month earlier, in November 2025, CVS paid $18.3 million to settle allegations that its pharmacies submitted claims to California’s Medi-Cal program using false electronic certifications between 2010 and 2021.4HHS Office of Inspector General. CVS Pharmacy, Inc. Corporate Integrity Agreements And in September 2024, CVS subsidiary Oak Street Health agreed to pay $60 million to resolve allegations that it ran a Medicare Advantage kickback program, paying third-party insurance agents $200 per referred senior and funneling more than $4 million to roughly 20,000 referrals between September 2020 and January 2022. Oak Street denied liability and said it had ended the program more than two years earlier. The whistleblower received $9.9 million.5Phillips & Cohen LLP. Oak Street Health Agrees to Pay CVS Pharmacy has since been placed under heightened scrutiny by the HHS Office of Inspector General for a ten-year period.
Kaiser Permanente’s $556 Million Medicare Advantage Settlement
In January 2026, the DOJ announced the largest False Claims Act settlement ever involving Medicare Advantage risk-adjustment fraud. Kaiser Permanente affiliates agreed to pay $556 million to resolve allegations that between 2009 and 2018, Kaiser operations in California and Colorado inflated Medicare payments by adding roughly half a million diagnosis codes to patient charts that either did not exist or had no connection to the visit in question. According to the government, Kaiser inserted the codes months or even a year after the original encounter, tracked physicians’ coding performance, and tied financial and professional consequences to coding goals.6STAT News. Kaiser Permanente DOJ Settle Major Medicare Advantage Fraud Case
The DOJ estimated the practice drew about $1 billion in taxpayer funds. Six whistleblower lawsuits filed by former Kaiser employees were consolidated into the case, and the relators collectively received $95 million.7Constantine Cannon. Kaiser Pays Record $556M to Settle Medicare Advantage False Claims Act Case Kaiser denied wrongdoing and said it settled to avoid prolonged litigation.
Aetna, Independent Health, and Seoul Medical Group
Medicare Advantage coding drew several other large settlements. In March 2026, Aetna agreed to pay $117.7 million to resolve two sets of False Claims Act allegations. The larger portion, $106.2 million, addressed a 2015 chart review program in which Aetna allegedly identified additional diagnosis codes to secure higher payments but failed to delete codes its own reviews found unsupported by medical records. The remaining $11.5 million resolved claims that from 2018 through 2023, Aetna submitted morbid obesity diagnoses for patients whose recorded body mass index was inconsistent with that diagnosis. A former Aetna coding auditor who brought the whistleblower case on the obesity claims will receive $2,012,500.8U.S. Department of Justice. Aetna Agrees to Pay $117.7 Million to Resolve False Claims Act Allegations
Independent Health, a Buffalo-area insurer, agreed to pay up to $98 million for a similar scheme. From 2011 through at least 2017, the insurer allegedly used a subsidiary called DxID to comb through medical records retroactively and query physicians to identify diagnoses that weren’t supported by patient charts, ultimately submitting over 125,000 unsupported codes. The settlement includes a five-year Corporate Integrity Agreement requiring annual outside audits of its Medicare Advantage coding.9U.S. Department of Justice. Medicare Advantage Provider Independent Health Pay $98M to Settle False Claims Act Suit
Seoul Medical Group and its subsidiary Advanced Medical Management paid over $62 million to resolve allegations that between 2015 and 2021 they submitted false diagnosis codes for spinal enthesopathy and sacroiliitis to inflate Medicare Advantage payments. The group’s former president and majority owner, Dr. Min Young Cha, personally paid $1.76 million.10U.S. Department of Justice. Medicare Advantage Provider Seoul Medical Group and Related Parties Pay Over $62M to Settle
Teva Pharmaceuticals: $450 Million for Kickbacks and Price-Fixing
In October 2024, Teva Pharmaceuticals agreed to pay $450 million to resolve two distinct allegations. The first involved funneling money through purportedly independent copay assistance foundations to cover Medicare patients’ out-of-pocket costs for the multiple sclerosis drug Copaxone, effectively paying to keep patients on the drug while raising its price. The second involved conspiring with generic drug manufacturers to fix prices on pravastatin, clotrimazole, and tobramycin. Teva had already paid a separate $225 million criminal penalty tied to the price-fixing conduct.11U.S. Department of Justice. Drug Maker Teva Pharmaceuticals Agrees to Pay $450M in False Claims Act Settlement
Horizon Blue Cross Blue Shield’s $100 Million New Jersey Settlement
In November 2025, New Jersey Attorney General Matthew Platkin announced a $100 million settlement with Horizon Blue Cross Blue Shield of New Jersey, which the state called the largest non-Medicaid False Claims Act recovery in its history. The state alleged Horizon fraudulently won a 2020 contract to administer the State Health Benefits Program and the School Employees’ Health Benefits Program by bidding on terms it knew it could not meet. A critical provision required Horizon to charge the state whichever was lower: the amount a provider billed, or the rate Horizon had negotiated with that provider. According to the state, Horizon analyzed its own claims data before bidding, determined it could not comply with the “lesser of” requirement, won the contract anyway, and then systematically overcharged the state while issuing fraudulent Explanations of Benefits to plan members to conceal the overbilling.12New Jersey Office of the Attorney General. AG Platkin: Horizon Agrees to Settle False Claims Act Case for $100 Million
The case grew out of a 2021 qui tam lawsuit filed by six individuals. Five of them will share a $12 million relator payment; the sixth, a former state health benefits official, was excluded because she learned of the alleged conduct in her official capacity.13New Jersey Monitor. Horizon Settlement New Jersey
Sutter Health’s $800 Million in Antitrust Settlements
Northern California’s dominant hospital system has now paid over $800 million across two antitrust cases alleging it used its market power to drive up healthcare costs. A $575 million settlement finalized in 2021 resolved a case brought by the United Food and Commercial Workers and Employers Benefit Trust and the California Attorney General. The complaint accused Sutter of “all-or-nothing” contracting, anticompetitive bundling, and restrictions on access to lower-cost health plans. The deal installed a ten-year compliance monitor and required operational reforms, including an end to surprise out-of-network charges and new price transparency obligations.14California Office of the Attorney General. Attorney General Bonta Announces Final Approval of $575 Million Settlement With Sutter
A second case, Sidibe, et al. v. Sutter Health, was filed in 2012 on behalf of more than 3 million individuals and businesses who paid premiums to major California insurers. Plaintiffs alleged that Sutter’s contract terms caused insurers to overpay for hospital services, inflating premiums. The case settled on the eve of trial in March 2025 for $228.5 million, roughly 53% of the estimated $411 million in alleged overpayments.15STAT News. Sutter Health Settles Antitrust Case for Nearly $230 Million The court granted final approval in November 2025 and claims administration is ongoing.16Sutter Health Premium Lawsuit. Sidibe, et al. v. Sutter Health Settlement
Healthcare Data Breach Settlements With Open Claims
A separate line of settlements addresses breaches that exposed patients’ personal and medical information. Several recent class action resolutions offer cash and credit monitoring to affected individuals.
- Signature Performance agreed to an $8.5 million settlement after a January 2024 cyberattack on the healthcare billing company exposed data for approximately 232,315 individuals, including Social Security numbers, medical histories, and insurance information. Class members can claim up to $5,000 for documented losses or roughly $200 without documentation, plus three years of medical identity monitoring. California residents may receive an additional $200 statutory payment. The claims deadline is May 7, 2026.17Signature Data Breach Settlement. Curtis McClean, et al. v. Signature Performance, Inc. Data Breach Settlement
- Hospital Sisters Health System reached a $7.6 million settlement over a ransomware attack between August 16 and 27, 2023, that compromised Social Security numbers, driver’s license numbers, and health insurance details. Claimants can receive up to $5,000 for documented losses or an alternative cash payout, plus two years of financial monitoring and $1 million in identity theft insurance.18HSHS Data Settlement. HSHS Data Breach Settlement FAQ
- Navvis & Company and SSM Health agreed to a $6.5 million settlement after a July 2023 ransomware attack exposed data for roughly 2.8 million individuals, including Social Security numbers and clinical records. The settlement pays up to $2,000 for ordinary losses, $5,000 for documented identity theft, and two years of credit monitoring.19HIPAA Journal. Navvis SSM Health Data Breach Settlement
- Capital Health Systems reached a $4.5 million settlement over an incident between November 11 and 26, 2023, that potentially compromised data for more than 503,000 individuals. Class members can claim up to $5,000 for documented losses or an estimated $100 alternative payment, plus three years of credit monitoring. The claims deadline is April 6, 2026.20HIPAA Journal. Capital Health Class Action Data Breach Settlement
- A separate SSM Health case alleged the system disclosed patient data to third-party tracking technologies through its MyChart portal between July 2020 and February 2023 without consent. The court granted final approval in November 2025, and claimants received $31.50 payments distributed in March 2026.21SSM Health Data Settlement. SSM Health Data Settlement FAQ
The Scale of 2025 Enforcement
The DOJ reported over $6.8 billion in total False Claims Act settlements and judgments for fiscal year 2025, with healthcare accounting for more than $5.7 billion, a record. Enforcement centered on Medicare Advantage coding fraud, prescription drug kickbacks, and medically unnecessary care.22U.S. Department of Justice. False Claims Act Settlements and Judgments Exceed $6.8B in Fiscal Year 2025 Whistleblowers drove much of the activity: a record 1,297 qui tam cases were filed in 2025, and relators received over $262 million in awards for successful healthcare fraud actions that year.23Healthcare Dive. Justice Department Recovered Record $5.7 Billion in Healthcare False Claims
The 2025 National Health Care Fraud Takedown, which the DOJ described as the largest in its history, charged 324 individuals across 50 federal districts, including 96 licensed medical professionals. The schemes targeted in that single operation accounted for over $14.6 billion in intended losses, more than double the previous record.24HHS Office of Inspector General. 2025 National Health Care Fraud Takedown