Aetna, the massive U.S. health insurance provider serving more than 36 million Americans, has agreed to pay $117.7 million to settle allegations it violated the False Claims Act by submitting or failing to correct inaccurate diagnosis codes for Medicare Advantage enrollees, the . Federal prosecutors said the insurer, which is a subsidiary of CVS Health, inflated risk scores used by Medicare to determine payments, allowing the company to receive higher reimbursements for patients who were not as sick as reported. The government also alleged Aetna improperly coded some patients as having morbid obesity despite medical records — including BMI measurements — that did not support the diagnosis. The settlement resolves the allegations without a determination of liability, and a whistleblower who brought part of the case will receive about $2 million from the recovery.
Researchers have launched an open-access Human Organ Atlas, an interactive online platform that allows users to explore detailed 3D images of intact human organs — from full organs down to near-cellular structures. Published in , the project...
Key Takeaways Aetna allegedly leveraged inaccurate Medicare Advantage diagnosis coding to elevate risk adjustment payments, including morbid obesity coding inconsistent with clinical documentatio...