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. 

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.

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