Aetna Pays $117.7 Million to Resolve Medicare Advantage Coding Allegations
TL;DR
Aetna will pay $117.7 million to settle False Claims Act allegations that it submitted or failed to withdraw inaccurate diagnosis codes to inflate Medicare Advantage payments, including morbid obesity codes for 2018–2023, and related issues from a 2015 chart-review program; a whistleblower, a former Aetna risk-adjustment coder, will receive about $2.01 million. The case was pursued by the DOJ Civil Division, Fraud Section, and HHS-OIG with the U.S. Attorney’s Office for the Eastern District of Pennsylvania.
Topics:businesshealthcare#aetna#false-claims-act#healthcare#healthcare-fraud#medicare-advantage#whistleblower
- Aetna Agrees to Pay $117.7 Million to Resolve False Claims Act Allegations Department of Justice (.gov)
- CVS Health’s Aetna to Pay $117.7 Million to Resolve False Claims Act Allegations WSJ
- Insurance company to pay $117M settlement to resolve Medicare misdiagnosis allegations ABC27
- DOJ: Aetna to pay $117.7M for alleged fraudulent Medicare payments WTAJ
- Aetna to pay $118M to settle Medicare Advantage upcoding claims Modern Healthcare
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