Key Takeaways:
Aetna, a unit of CVS Health (CVS), has agreed to a $117.7 million settlement over allegations involving the False Claims Act. The Justice Department contends that Aetna submitted misleading patient diagnosis information for its Medicare Advantage participants. This inaccurate data was allegedly used to improperly increase the company's Medicare payments. The government accuses Aetna of failing to retract the incorrect information and not reimbursing Medicare for these overpayments. Additionally, Aetna reportedly misrepresented the accuracy of the submitted data in official certifications to the Centers for Medicare & Medicaid Services (CMS).
CVS Health offers a diverse set of healthcare services. Its roots are in its retail pharmacy operations, where it operates over 9,000 stores primarily in the US. CVS is also a large pharmacy benefit manager (acquired through Caremark), processing about 2 billion adjusted claims annually. It operates a top-tier health insurer (acquired through Aetna) through which it serves about 27 million medical members. The acquisition of Oak Street Health added primary care services to the mix, which could have significant synergies with all existing business...
Dive Brief: CVS’ health insurer Aetna has agreed to pay $117.7 million to resolve allegations that it submitted incorrect diagnoses for its Medicare Advantage members in order to increase its rei...