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Anthem Sued for Fraud — Medicare Over-billing at Issue

Posted By Administration, Tuesday, April 7, 2020
Updated: Friday, April 3, 2020


Anthem is being sued for overcharging the U.S. government for services provided to Medicare patients. The suit was filed in Manhattan. It says Anthem ratcheted up costs and turned inaccurate bills for diagnostic data.

Hundreds of thousands of patients covered by Medicare Part C were affected.

Anthem says no way did that happen and it will vigorously defend. The company said this is an attempt by the government to hold it and other insurers to risk adjustment practice standards while it provides zero guidance.

“The government is trying to hold Anthem and other Medicare Advantage plans to payment standards that CMS (Centers for Medicare and Medicaid Services) does not apply to original Medicare, and those inconsistent standards violate the law,” Anthem said in a statement.

The government sys Anthem is supposed to check for billing accuracy via its chart review program. That program just added new claims and didn’t leave out the unsubstantiated charges.

“Anthem made ‘revenue enhancement’ the sole purpose of its chart review program, while disregarding its obligation to find and delete inaccurate diagnosis codes, because Anthem prioritized profits over compliance,” the government alleges in the lawsuit.

Source link:Business Insurance America

Tags:  Healthcare fraud Medicare 

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