Feds Accuse Anthem Of Bilking Medicare With Faulty Data

Law360 (March 27, 2020, 8:17 PM EDT) -- The Manhattan U.S. attorney’s office on Thursday brought a False Claims Act suit against Anthem Inc., saying it fleeced Medicare by submitting inaccurate diagnostic data that allowed the insurer to reap millions of dollars in overcharges from the government.

According to the complaint, Anthem failed to ensure the accuracy of risk adjustment diagnosis data — which the Centers for Medicare and Medicaid Services uses to calculate payments to Medicare Advantage organizations like Anthem — for hundreds of thousands of patients covered by Medicare Part C.

Prosecutors say Anthem had implemented a “chart review” program which was supposed to ensure the diagnostic...

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