Elevance Health faces federal lawsuit alleging Medicare Advantage fraud – Indianapolis Business Journal

Indianapolis-based Elevance Health Inc. is facing a federal lawsuit alleging the company defrauded the U.S. government of millions of dollars by falsely certifying incorrect diagnostic data from doctors and other healthcare providers.

In a ruling announced this week, Judge Andrew Carter of the U.S. District Court for the Southern District of New York said Elevance, which was known as Anthem Inc. until a rebrand in late June, n did not show that the lawsuit should be dismissed for lack. of materiality.

Carter said the total amount allegedly overpaid by the Centers for Medicare and Medicaid Services to Elevance could total well over $100 million, making government costs “substantial and not just administrative.”

The U.S. Department of Justice filed a civil fraud suit against Elevance in March 2020

The lawsuit accuses Elevance, one of the nation’s largest providers of Medicare Advantage plans for seniors, of causing the Centers for Medicare and Medicaid Services to overpay the company based on inaccurate and inflated information in early 2014. and early 2018.

Medicare Advantage plans are health insurance policies for seniors operated by private insurance companies under contract with Medicare. Under this program, the government pays private insurers a monthly amount to provide health care benefits to the elderly.

Medicare Advantage plans are extremely popular for their wide range of benefits, with monthly premiums often lower than traditional Medicare.

Under these plans, Elevance provides health coverage to Medicare beneficiaries. In return, he received payments from the government based on patient health and demographic factors.

The Justice Department sued Elevance under the federal misrepresentation law and is seeking civil penalties and treble damages.

The case is one of several civil suits the Justice Department has brought against companies that participate in Medicare Advantage.

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