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Justice Department sues Anthem for
alleged diagnosis fraud scheme totaling
millions of dollars

Original Article

Posted By: earlybird, 3/27/2020 1:21:51 PM

The Justice Department sued Anthem, one of the nation’s largest health insurance providers, over an alleged fraudulent scheme to inflate diagnosis numbers to scam Medicare out of millions of dollars a year. It is among the largest Medicare fraud lawsuits yet. Investigators said that they filed this civil lawsuit because Anthem “falsely certified the accuracy of the diagnosis data it submitted to the Centers for Medicare and Medicaid Services for risk-adjustment purposes under Medicare Part C and knowingly failed to delete inaccurate diagnosis codes” between 2014 and 2018.

Comments:

I had read some months ago that Anthem was Paul Ryan’s biggest supporter. Cannot find the link...

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Reply 1 - Posted by: lakerman1 3/27/2020 1:41:35 PM (No. 359941)
Let's be careful here. for the past three or four decades, health care providers and Med9icare have done a complicated dance on coding of bills. Mrs. Lakerman was an office manager for a family practice physician 30 years ago, and I remember she attended a workshop devoted to0 'unbundling' medicare charges - that is, using more codes to enhance billings. It was perfectly legal. Sometimes the justice department files lawsuits to scare people, in my opinion. a few years ago, they went after the cardiologist group at UPMC Hamot, alleging, based on a whistleblower's complaint, that the cardiologists were ordering excessive, unnecessary tests. Eventually, all charges were dropped. Deep State justice people must want to distract us from the real problems in the U.S.
3 people like this.

Reply 2 - Posted by: lakerman1 3/27/2020 1:55:58 PM (No. 359963)
Oops. UPMC Hamot is located in Erie, Pa.
0 people like this.

Reply 3 - Posted by: Mushroom 3/27/2020 3:29:04 PM (No. 360070)
Unbundling explains why I see repeated entries in my insurance company's EOB saying something like "Procedure/Test covered under previously processed code" I always looked at it as a contract issue. Hospital negotiated for $X for a Happy Meal and then try to bill extra for Fries which was included in X. Seems to me Medicare is tired of the game.
8 people like this.

Reply 4 - Posted by: earlybird 3/27/2020 3:44:55 PM (No. 360082)
Re #1, what was legal 30 years ago is not necessarily legal today. My longtime friend, who has her own independent medical billing service, says the rules have tightened up quite a bit since she began - about 30 years ago...
2 people like this.

Reply 5 - Posted by: earlybird 3/27/2020 3:45:50 PM (No. 360083)
PS I am not easily distracted. Medicare overbilling costs us - the taxpayers - a ton of money.
4 people like this.

Reply 6 - Posted by: MrDeplorable 3/27/2020 4:42:41 PM (No. 360133)
What Anthem is doing is putting diagnoses and procedures in higher classifications to justify higher payments, a practice that is called "up-coding" which if a physician does it, is a FELONY and he or she can go to jail. Ought to be interesting to see what happens to the HMFICs at Anthem who authorized the clerks to do this, then again, we all know what will happen: nothing.
4 people like this.

Reply 7 - Posted by: RedWhite&Blue2 3/27/2020 7:20:37 PM (No. 360280)
Sucks to be on Medicare It’s elder abuse!
3 people like this.

Reply 8 - Posted by: Strike3 3/27/2020 7:58:23 PM (No. 360324)
The government expanded this list of diagnosis codes in version ICD-10, unnecessarily complicating the entire coding process and causing doctors to lose significant time in doing paperwork. Blaming the insurance company for the problem is passing the buck but I suspect that all of the big players are playing the same game only have not been caught yet. Money from the government is tracked far less accurately than money from big business.
0 people like this.

Reply 9 - Posted by: ColonialAmerican1623 3/28/2020 1:33:03 AM (No. 360483)
I once told my doctor that as a Medicare patient, I felt like a walking dollar sign. He didn't think it was funny. Me either. The first video with the doctor 'choosing which patient gets the ventilator' must have posted on here recently. Thank gawd I don't live in NYC.
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