Health Care Dive.
- The U.S. Department of Justice filed a lawsuit against the nation’s second-largest private insurer, Anthem, for allegedly failing to correct inaccurate diagnosis codes related to its Medicare Advantage business and receiving millions in improper payments from CMS.
- DOJ claims Anthem put its profits ahead of compliance and knowingly failed to update the accurate diagnosis codes between 2014 and 2018. This generated at least $100 million in additional revenue each year, according to the lawsuit.
- Anthem said it plans to vigorously defend its practices. “We think the agency should update regulations if it would like to change how it reimburses plans for services delivered,” the company said in a statement.