BILLING AND CODING—SETTLEMENT... - VitalLaw.com
The government alleged Aetna knowingly submitted unsupported diagnosis codes, resulting in overpayments by Medicare. Aetna Inc. has agreed to pay a total of $117.7 million to resolve two separate ...
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The materiality of alleged violations of federal fraud statutes, including the False Claims Act (FCA), is expected to increase in importance given a recent U.S. Supreme Court decision and the shifting priorities at the Department of Justice (DOJ) for federal contractors.
In United States v. Kousisis, 145 S. Ct. 1382 (2025), the Supreme Court held that federal mail and wire fraud liability can extend to misrepresentations even without proof of economic loss. The ruling comes as the White House, with Executive Order 14173 (“Ending Illegal Discrimination and Restoring Merit-Based Opportunity”) (EO), seeks to make compliance with Title VII of the Civil Rights Act a material contract term and the DOJ prioritizes its enforcement efforts under the FCA.
...The government alleged Aetna knowingly submitted unsupported diagnosis codes, resulting in overpayments by Medicare. Aetna Inc. has agreed to pay a total of $117.7 million to resolve two separate ...