Federal officials announced this week that one of the nation’s largest health insurers has agreed to pay $117.7 million to resolve fraud allegations.
The False Claims Act (FCA) case involved Aetna, Inc., which the U.S. Department of Justice (DOJ) said failed to withdraw inaccurate and untruthful diagnosis codes in order to increase the payments it received from Medicare, and falsely certified in writing to the Centers for Medicare & Medicaid Services (CMS) that their data was sound.
“The government pays private insurers over $530 billion each year to care for Americans enrolled in Medicare Advantage (MA),” U.S. Assistant Attorney General Brett A. Shumate of the DOJ’s Civil Division said in a statement. “We will continue to hold accountable insurers that knowingly submit inaccurate or unsupported diagnoses to improperly inflate reimbursement.”
“The government pays Medicare Advantage Organizations (MAOs) to facilitate vital healthcare to our seniors and other vulnerable citizens. When corporations or individuals threaten the Medicare Advantage program by diverting those limited government resources through fraud, waste, or abuse, we will continue to pursue all available remedies against them,” U.S. Attorney David Metcalf of the Eastern District of Pennsylvania added.
Specifically, the DOJ explained in a press release, for the 2015 payment year, Aetna operated a “chart review” program in which it paid coders to review medical records and identify all medical conditions...
Police have launched an investigation into alleged false accusation by Park Cheol-min, a former member of the Seongnam International Mafia. Park, ahead of the 2022 presidential election, raised al...