The Department of Justice is charging Anthem with fraud for getting thousands and thousands of dollars in danger adjustment payments by inflating the severity of ailment for beneficiaries in its Medicare Edge designs.
The civil lawsuit was submitted Friday in the U.S. District Court docket in the Southern District of New York. The federal government wants a jury trial to ascertain monetary damages and to recover restitution.
Even so, Anthem contends it has carried out practically nothing erroneous and reported it intends to “vigorously defend our Medicare danger adjustment tactics.” The DOJ has violated the legislation in holding Medicare Edge designs to payment specifications that are not applied to standard Medicare, the company reported by assertion.
“This litigation is the newest in a sequence of investigations on Medicare Edge designs,” Anthem reported. “The federal government is hoping to hold Anthem and other Medicare Edge designs to payment specifications that CMS