By: Justin L. Mack
The U.S. Department of Justice has filed a lawsuit against Anthem claiming the Indianapolis-based health insurance provider knowingly submitted inaccurate Medicare Advantage information to gain additional revenue from the government.
But Anthem officials are defending the company’s practices, stating that the government is violating the law with inconsistent payment standards between Medicare Advantage and original Medicare.
The lawsuit, filed Thursday in the U.S. District Court in the Southern District of New York, claims Anthem violated the False Claims Act by submitting inaccurate risk adjustment diagnosis data to the Centers for Medicare and Medicaid Services, or CMS, for “hundreds of thousands of Medicare beneficiaries covered by the Medicare Part C plans operated by Anthem.”