Aetna Inc., a major US health insurer and subsidiary of CVS Health, has agreed to pay $117.7 million (88.7 million) to resolve allegations that it violated federal fraud laws by submitting inaccurate diagnosis codes to inflate its payments from the Medicare Advantage programme.
The settlement, announced by the US Department of Justice on Wednesday, brings to a close claims that the insurer made false and misleading submissions to federal healthcare authorities over several years.
Under the terms of the settlement, Aetna will pay $117.7 million (88.7 million) to resolve allegations brought under the False Claims Act, a federal law that allows the government to pursue civil penalties when entities knowingly submit false claims for government funds.
In an official statement, the Justice Department said Aetna submitted inaccurate and untruthful diagnosis data to the Centers for Medicare & Medicaid Services (CMS) in order to inflate the risk‑adjusted payments it received for Medicare Advantage Plan enrollees. CMS administers the Medicare Advantage programme, which pays private insurers more for beneficiaries expected to have higher healthcare costs.
The complaint alleged that Aetna failed to delete or withdraw inaccurate diagnosis codes after chart reviews revealed they were unsupported by medical records, as required to ensure payments were based on accurate clinical information.
It further alleged that between 2018 and...
Who: A California federal judge dismissed a class action lawsuit filed against Apple Inc. Why: The judge determined the complaint failed to plausibly allege that Apple’s claims of carbon neutra...