WILLIAMSVILLE, N.Y. — An independent health association will pay nearly $100 million for alleged fraud against the government.
U.S. prosecutors have announced that the company is suspected of violating the False Claims Act by knowingly submitting or causing Medicare to submit invalid diagnosis codes. Subsequently, Medicare Advantage Plus customers' payments increased and were impacted.
Medicare beneficiaries have the option of enrolling in a Medicare Advantage plan. Medicare Advantage plans are paid a per capita amount to provide Medicare-covered benefits to beneficiaries enrolled in one of the plans.
Independent Health must pay back $98 million to resolve the allegations.
Assistant Attorney General Michael Granston of the Justice Department's Civil Division added: “The government expects those participating in Medicare Advantage to provide accurate information to ensure enrolled beneficiaries are paid appropriately for the care they receive. Today's results , sends a clear message to the Medicare Advantage community that the United States will take appropriate action against those who submit intentionally inflated reimbursement claims.”
As part of the settlement, Independent Health will “make a payment of $34.5 million and a contingency payment of up to $63.5 million on behalf of itself and DxID, which ceased operations in 2021,” according to the U.S. Attorney's Office. It is said that it is planned. The companies will also enter into a five-year “Corporate Integrity Agreement” with the Department of Health and Human Services' Office of Inspector General.
“Medicare Advantage plans that seek to profit from federal programs must be held accountable through strict oversight and enforcement,” said Christian J. Schrank, Deputy Inspector General of the Department of Health and Human Services Office of Inspector General. said. “HHS-OIG continues to work with our law enforcement partners to root out fraud, waste, and abuse in federal health care programs.”
Independent Health released a statement Friday night that read in full:
“The Justice Department's claims are mere allegations, and no determination of liability has been made. This settlement does not admit wrongdoing. Instead, it adds further confusion, expense, and litigation that has dragged on for more than a decade. , uncertainty can be avoided.
“This dispute had nothing to do with the quality of care or services our members received, or the payment of their insurance benefits. We are working with the Department of Justice to resolve this matter and are currently working with We are moving forward with a focus on maintaining the care needs of our members.
“As an organization, we are committed to complying with all regulatory requirements and are proud to be a leading and highly rated Medicare Advantage plan, both regionally and nationally. We consistently receive high ratings for quality and customer service from the Centers for Medicaid Services (CMS) and have been repeatedly recognized by CMS as one of the highest-rated Medicare Advantage plans in the nation.
“Independent Health is dedicated to faithfully fulfilling our mission of serving our members with unparalleled quality and service while contributing to the health of our communities.”
