Elevance Health facing Medicare Advantage fraud suit from DOJ

Elevance Health is facing a federal lawsuit alleging the payer received more than $100 million in overpayments from CMS after a judge declined to dismiss the suit, the Indianapolis Business Journal reported Oct. 5. 

Advertisement

Elevance failed to show the lawsuit should be dismissed for lack of material, U.S. District Court Judge Andrew Carter said in a ruling announced this week. 

The Justice Department claims the Indianapolis-based insurer received millions in overpayments for Medicare Advantage plan enrollees by falsely certifying incorrect diagnosis data between 2014 and 2018, the IBJ reported. 

The Justice Department is cracking down on fraudulent Medicare Advantage coding and billing, filing lawsuits against several payers for alleged overpayments. UnitedHealth Group, Cigna and Kaiser Permanente have faced similar lawsuits, The Washington Post reported in June.

At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.

Register to Attend Webinar

Read. Deleted. Ignored. What It Takes to Drive Behavior Change and Lower the Cost of Care

Tuesday, August 4
11:00 AM - 12:00 PM CDT

Presenters: Koleen Cavanaugh, Independence Blue CrossBukata Hayes, HMO Minnesota (Blue Plus)Nathan Foco, Select HealthTrish Cox, SCAN Health PlanJonas Puente, ZS Associates

Advertisement

Next Up in Payer

Advertisement

Comments are closed.