A federal judge has sided with the Justice Department in its bid to depose a former senior executive at Elevance Health over allegations that the insurer submitted fraudulent Medicare Advantage claims to the government.
On May 20, the judge ordered Peter Haytaian, former president of Elevance’s government business and most recently president of the Carelon division, to sit for a 3.5-hour interview under oath with prosecutors. The court also denied Elevance’s request to restrict the topics on which Mr. Haytaian can be questioned, noting that the limited time will require the government to carefully select what it asks.
The ruling is the latest development in the government’s ongoing lawsuit that alleges Elevance, then Anthem, violated the False Claims Act by knowingly failing to delete inaccurate Medicare Advantage member diagnosis codes submitted to CMS for risk adjustment purposes. The government claims Elevance instead used a retrospective chart review program to identify additional codes that could generate higher payments, describing the program as generating more than $100 million per year in additional revenue during certain periods. The case, first filed in 2020, survived Elevance’s bid to dismiss it in 2022 and has been in extended discovery since.
The Justice Department is arguing that Mr. Haytaian was directly involved in Anthem’s retrospective chart review program and possesses unique, firsthand knowledge of key decisions related to the company’s Medicare Advantage business practices. It also argued he should be questioned about his involvement in decisions around employee terminations, provider sanctions, and communications with Anthem’s board about the chart review program, as well as what it described as a “revenue-focused culture” at the company.
Elevance, which declined to comment on the latest ruling and had sought to block the deposition entirely, argued that Mr. Haytaian qualified as a protected “apex witness” given his seniority. Earlier in the month, Mr. Haytaian disputed the government’s characterization of his involvement, saying his role was limited to high-level oversight and that he was not personally involved in designing, implementing, or approving how the chart review program was configured or operated during the period at issue.
Mr. Haytaian served as president of the government business unit, which includes the MA business, from June 2014 through March 2018, a period that overlaps with the diagnosis codes at issue, which span dates of service from 2012 through the end of 2015. From March 2018 onward, his roles had no supervisory connection to MA operations. Most recently, he had served as president of Elevance’s health services division, Carelon, until May 4.
Elevance announced in late February that Mr. Haytaian was leaving the company to devote more time to family commitments, though it said he will remain as a special advisor to President and CEO Gail Boudreaux through the end of 2026. According to an April 27 letter filed with the court, the government said it first contacted Elevance about deposing Mr. Haytaian on Feb. 24, two days before the company announced his departure. Elevance has said the deposition request is unrelated to his exit.
The judge’s order also addressed several other outstanding discovery disputes in the case. Elevance must produce revenue forecast adjustment documents from 2012 through 2018, compensation policies and incentive criteria for 27 employees involved in risk adjustment and chart review, and board of director minutes, with some redactions permitted. The court denied the government’s request to expand document collection to eight new custodians and denied Elevance’s motion to compel additional records related to CMS RADV audits.
Separately, Elevance has been navigating a dispute with CMS over its MA risk adjustment data submission practices. In April, the company disclosed it had set aside $935 million to cover costs from a possible suspension of enrollment into some of its plans following alleged noncompliance with federal rules. Elevance has framed that dispute as a historical payment disagreement unrelated to its current practices.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
