Indianapolis-based health insurance giant Elevance Health, previously Anthem, Inc., will have to face a federal lawsuit alleging it pocketed at least tens of millions of dollars by submitting inaccurate claims to the U.S. Centers for Medicaid & Medicare Services.
The original lawsuit, filed by the U.S. Department of Justice in March 2020, alleges the company did not check diagnosis codes it submitted for reimbursement between early 2014 and 2018 for its Medicare Advantage plans for senior citizens. These plans are run by private insurers like Elevance Health that contract with CMS. Around 28.7 million people –– nearly half of all eligible Medicare beneficiaries –– are covered under these plans.
Earlier this week, a U.S. district judge in Manhattan ruled the company failed to prove that the lawsuit lacked materiality. Judge Andrew Carter said the financial costs to the government were “substantial” and not “merely administrative” –– amounting to more than $100 million.