![]() ![]() ![]() The 2023 growth rate is set at 4.88% in the rate announcement released in July by the Centers for Medicare and Medicaid Services.Īs enrollment in the Medicare Advantage program grows, so do concerns and uncertainty over the profits providers are reaping and whether "overpayment" is an issue.Ī report from the Brookings Institution indicates the five major insurers, UnitedHealthcare, Humana, Aetna, Kaiser Permanente and Anthem (now Elevance), are allegedly padding their bottom lines by disguising profits as costs. This is an increase over the 7.98% proposed in the February advance notice. Medicare Advantage plan payments are expected to get an 8.5% revenue increase for 2023. The DOJ, seeking civil fines and triple damages, sued the insurer under the False Claims Act, which bars false payment claims. The DOJ initially filed suit in March 2020, an action that stemmed from Anthem's operation of dozens of Medicare Advantage plans. ![]() A motion to dismiss was similarly rejected. The government alleges the insurer sought to increase revenue by not deleting invalid codes.Īnthem, which rebranded this year as Elevance, had sought to strike portions of the complaint under rule 12(f) of the Federal Rules of Civil Procedure, which says the court may strike any redundant, immaterial, impertinent, or scandalous matter," but this effort was denied. District Judge Andrew Carter of Manhattan estimated the alleged overpayments far exceeded $100 million over a span from 2014 to 2018. In the decision, released Friday, September 30, U.S. The suit alleges that the supposedly inaccurate diagnosis data allowed Anthem to collect tens of millions of dollars in annual overpayments. Photo: Pichsakul Promrungsee EyeEm/Getty ImagesĪnthem has been accused of not verifying the accuracy of diagnosis codes it submitted when seeking reimbursements over a four-year span, and a federal judge has now ordered the insurer to face a lawsuit from the U.S. ![]()
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