By Kelly Cloonan
CVS Health's Aetna unit agreed to pay $117.7 million to resolve allegations that it violated the False Claims Act.
The Justice Department said the settlement stems from allegations that claim Aetna submitted false patient diagnosis data for its Medicare Advantage Plan enrollees in order to get higher monthly payments from the Centers for Medicare and Medicaid Services.
Under the Medicare Advantage program, beneficiaries can choose to opt out of traditional Medicare and enroll in private plans offered by health insurers like Aetna. Those insurers receive a fixed monthly amount that tends to be higher for sicker beneficiaries that are expected to incur higher healthcare costs.
The allegations claim that Aetna submitted or failed to delete or withdraw inaccurate patient diagnosis codes in order to get higher payments from CMS.
"Medicare Advantage relies on accurate reporting," said Scott Lampert, the Department of Health and Human Services' acting deputy inspector general for investigations. "Today's settlement makes clear that no company is beyond accountability, no matter how large or well known."
Aetna said it disagrees with the allegations and that its decision to settle the allegations allows it to avoid the uncertainty and expenses that come with prolonged litigation.
"Aetna continues to disagree with the DOJ's industry-wide allegations, and this settlement should not be seen as an acknowledgment of liability," a spokesperson for Aetna said.
Write to Kelly Cloonan at kelly.cloonan@wsj.com
(END) Dow Jones Newswires
03-11-26 1349ET
