The United States Department of Justice has issued a report listing the settlements and judgments it reached under the False Claims Act for Fiscal Year 2023. The report includes settlements with Medicare Advantage plans in cases alleging that the plans for knowingly submitting inaccurate information regarding the health status of their beneficiaries to increase their members’ risk adjustment scores, which increases the government’s payments to the plans.
In Fiscal Year 2023, Cigna agreed to pay the government $172 million for its submission of additional diagnosis codes to Medicare after chart reviews conducted by third party vendors. Similar cases are pending against UnitedHealth Group, Elevance Health (formerly Anthem) and Kaiser Permanente.
The False Claims Act imposes treble damages on anyone who knowingly and falsely claims monies from the United States or who knowingly fails to pay money owed to the United States. In the healthcare sector, False Claims Act actions often arise in conjunction with the Medicare, Medicaid and Tricare programs.
The DOJ’s press release with the Fiscal Year 2023 results is linked here.