Anthem Sued for Medicare Fraud by U.S. Attorney in New York

(Bloomberg) -- Anthem Inc. overcharged the U.S. government by millions of dollars for services provided to Medicare patients, according to a fraud lawsuit filed by prosecutors.

The U.S. Attorney’s office in Manhattan alleges that the medical insurance giant jacked up its Medicare reimbursement by submitting inaccurate diagnostic data for hundreds of thousands of patients covered by Medicare Part C.

The company said it intends to vigorously defend against the lawsuit, which is said is part of a pattern of litigation that attempts to hold it and other plans to “a standard on risk adjustment practices, without providing clear guidance.”

“The government is trying to hold Anthem and other Medicare Advantage plans to payment standards that CMS does not apply to original Medicare, and those inconsistent standards violate the law,” Anthem said in a statement, referring to the acronym for the Centers for Medicare and Medicaid Services.

Prosecutors contend Anthem’s “chart review program” was supposed to check the accuracy of what it had previously billed. But the program only added new claims for reimbursement while failing to weed out unsubstantiated charges, according to the complaint filed Thursday in federal court.

“Anthem made ‘revenue enhancement’ the sole purpose of its chart review program, while disregarding its obligation to find and delete inaccurate diagnosis codes, because Anthem prioritized profits over compliance,” prosecutors alleged.

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