In a press release published on December 20, the The US Department of Justice (DOJ) announced which is based in New York Independent Health has agreed to pay up to $98 million in violation of the False Claims Act by knowingly submitting invalid diagnosis codes to Medicare for Medicare Advantage plan enrollees to increase payment.
According to the news summary, Independent Health allegedly created a wholly owned subsidiary, DxID LLC, to retrospectively search medical records and query doctors for information supporting additional diagnoses that could be used to generate higher risk scores. The United States filed a complaint alleging that, from 2011 to at least 2017, Independent Health, with the assistance of DxID and its founder and CEO, Betsy Gaffney, knowingly submitted diagnoses to CMS that were not supported by beneficiaries’ medical records. . inflate Medicare payments to Independent Health.
“Today’s outcome sends a clear message to the Medicare Advantage community that the United States will take appropriate action against those who knowingly submit inflated reimbursement claims,” Assistant Attorney General Michael Granston of the Division said in a statement. Civilian of the Department of Justice.
“Medicare Advantage plans that attempt to cheat federal programs to make profits must be held accountable through rigorous oversight and enforcement,” said Deputy Inspector General Christian J. Schrank of the Department of Health and Human Services (HHS) Office of Inspector General. -OIG) in a statement.
