Anthem has been accused of not verifying the accuracy of diagnosis codes it submitted when seeking reimbursements over a four-year span, and a federal judge has now ordered the insurer to face a lawsuit from the U.S. government.
The suit alleges that the supposedly inaccurate diagnosis data allowed Anthem to collect tens of millions of dollars in annual overpayments.
In the decision, released Friday, September 30, U.S. District Judge Andrew Carter of Manhattan estimated the alleged overpayments far exceeded $100 million over a span from 2014 to 2018. The government alleges the insurer sought to increase revenue by not deleting invalid codes.
Anthem, which rebranded this year as Elevance, had sought to strike portions of the complaint under rule 12(f) of the Federal Rules of Civil Procedure, which says the court may strike any redundant, immaterial, impertinent, or scandalous matter," but this effort was denied. A motion to dismiss was similarly rejected.
WHAT'S THE IMPACT
The DOJ initially filed suit in March 2020, an action that stemmed from Anthem's operation of dozens of Medicare Advantage plans. The DOJ, seeking civil fines and triple damages, sued the insurer under the False Claims Act, which bars false payment claims.
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