Earlier this year, Eargo Inc. agreed to a $34.37 settlement with the United States Department of Justice (DOJ) over allegations that it submitted – or caused the submission of – claims for hearing aid devices for reimbursement to the Federal Employees Health Benefits Program (FEHBP) with unsupported hearing loss diagnosis codes.

The FEHBP is the largest employer-sponsored group health insurance plan in the world and is administered by the Office of Personnel Management (OPM). Some of the FEHBP health insurance plans offer a hearing aid benefit, though the exact benefits vary based on the plan. FEHBP carriers that offer a hearing aid benefit mandate that claims for hearing aid devices include a hearing loss-related diagnosis codes, which must be supported by a hearing loss diagnosis. Hearing loss diagnoses are typically based on hearing tests performed by health care providers.

The United States alleged that from January 2017 through January 2021, Eargo included unsupported hearing loss-related diagnosis codes on claims for hearing aid devices that it submitted to the FEHBP and on invoices that Eargo provided to FEHBP beneficiaries to obtain reimbursement for the hearing aids. The United States alleged that even after Eargo completed an internal review of its billing and coding practice sin January 2021, from February 1, 2021 through September 22, 2021, Eargo continued to include the unsupported hearing loss-related diagnosis codes on claims and superbills. Once Eargo was...

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