Aetna Inc. agreed to pay the US government $117,700,000 to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees, the US Attorney’s Office for the Eastern District of Pennsylvania said.
The government alleged that Aetna operated a “chart review” program where it retrieved medical records from healthcare providers and used diagnosis coders to identify additional medical conditions to submit to Medicare for increased payments, the announcement said Tuesday.
However, Aetna allegedly failed to delete or withdraw inaccurate diagnosis codes that would have required ...