Log in
Log in
Or log in with
GoogleGoogle
Twitter Twitter
Facebook Facebook
Apple Apple     
Sign up
Or log in with
GoogleGoogle
Twitter Twitter
Facebook Facebook
Apple Apple     
News
All NewsCompaniesIndexesCurrency / ForexCommoditiesCryptocurrenciesETFInterest RatesEconomyThemesSectors 

Anthem must face U.S. government lawsuit alleging Medicare Advantage fraud

10/03/2022 | 01:34pm EST
The logo for health insurance provider, Anthem, is displayed on a screen on the floor at the NYSE in New York

NEW YORK (Reuters) - A federal judge ordered Anthem Inc to face a U.S. government lawsuit claiming it submitted inaccurate diagnosis data, enabling the health insurer to fraudulently collect tens of millions of dollars in annual overpayments from Medicare.

In a decision released on Monday, U.S. District Judge Andrew Carter in Manhattan said the total alleged overpayment to Anthem appeared to be well over $100 million, making the government's financial costs "substantial and not merely administrative."

A lawyer for Anthem declined to comment. The Indianapolis-based insurer did not immediately respond to a request for comment.

The Department of Justice lawsuit filed in March 2020 stemmed from Anthem's operation of dozens of Medicare Part C plans, also known as Medicare Advantage, a privatized system that insures Americans who opt out of traditional Medicare.

Anthem was accused of not checking the accuracy of diagnosis codes it submitted when seeking reimbursements between early 2014 and early 2018, because deleting invalid codes would have reduced revenue.

One company executive was quoted in 2016 as saying Anthem viewed its "retrospective chart review," which supplemented codes it had already collected from doctors, as a "cash cow."

The Justice Department sued Anthem under the federal False Claims Act, which prohibits submitting false payment claims, and sought civil fines and triple damages. Carter's decision is dated Sept. 30.

Anthem's case is one of multiple Justice Department civil lawsuits against companies that participate in Medicare Advantage.

The government watchdog MedPac said excess Medicare Advantage billing linked to what it calls "coding intensity" reached $12 billion in 2020.

Enrollment in Medicare Advantage has doubled since 2013 to about 28.7 million, or approximately 49% of all eligible Medicare beneficiaries, MedPac said in July.

The case is U.S. v. Anthem Inc, U.S. District Court, Southern District of New York, No. 20-02593.

(Reporting by Jonathan Stempel in New York; Editing by Marguerita Choy)

By Jonathan Stempel


ę Reuters 2022
Stocks mentioned in the article
ChangeLast1st jan.
CARTER'S, INC. 0.10% 73.14 Delayed Quote.-27.81%
ELEVANCE HEALTH, INC. -0.07% 523.6 Delayed Quote.12.96%
Latest news "Economy"
12/02Countries split on plastics treaty focus as UN talks close
RE
12/02G7 agrees to cap Russian crude at $60 per barrel
RE
12/02Factbox-How many people might die, and why, if China loosens COVID restrictions
RE
12/02Beijing, Shenzhen loosen more COVID curbs as China easing gathers pace
RE
12/02Renault and Nissan forgo Dec. 7 announcement of new deal -JNN
RE
12/02Exclusive-Delta offers 34% pay raise to pilots in new contract
RE
12/02Delta pilots union says tentative contract deal repres…
RE
12/02Delta confirms it has reached an agreement in principl…
RE
12/02Exclusive: delta air lines offers 34% pay increase to pilots ove…
RE
12/02Zelenskiy: 60 grain vessels to depart from Ukraine
RE
Latest news "Economy"