Anthem not complying with Medicare payment investigation, feds say

The Justice Department is asking Anthem to testify in a federal investigation into how the health insurer billed for Medicare Advantage payments, according to court documents filed Aug. 21.

Federal regulators are investigating whether Anthem unlawfully obtained upward of hundreds of millions of dollars in Medicare risk-adjustment payments. The government wants to know if Anthem obtained these payments by knowingly submitting inaccurate data to Medicare for payment calculation.

In its filing, the Justice Department claims Anthem is "refusing to provide testimony about what policies and processes, if any, it utilized to ensure the validity of the provider-submitted diagnosis codes. There is no legal basis for this position," according to the filing.

The Justice Department asked the U.S. District Court for the Southern District of New York to order Anthem to testify on its inquiries. The court ordered Anthem to respond to the Justice Department's inquiries by Sept. 4. Anthem declined Becker's Hospital Review's request for comment.

In a response filed Aug. 21, Anthem said it objected the Justice Department's inquiries. Federal regulators originally requested Anthem's testimony on its risk-adjustment program and chart review in March, according to a filing outlining the health insurer's objections and responses to the civil investigative demand.  

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