Justice Department alleges data-mining company helped health plan overcharge millions

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The United States has filed a False Claims Act complaint against Buffalo, N.Y.-based Independent Health, its subsidiary DxID and former DxID CEO Betsy Gaffney. 

The complaint alleges Independent Health and data-mining company DxID submitted inaccurate information on its Medicare Advantage members' health to increase its reimbursement, according to a Sept. 14 Department of Justice news release.

DxID scanned medical records and allegedly reported incorrect "risk scores" for patients, which dictate payer reimbursement based on member health, the complaint alleges. By inflating patient risk scores, DxID netted Independent Health increased reimbursement, the complaint alleges.

When Independent Health was made aware of the issue, it failed to address the discrepancy, resulting in "tens of millions" of overcharges, according to Kaiser Health News.

Independent Health and DxID deny all allegations, a spokesperson told Becker's. 

"We will continue defending ourselves vigorously in court as we believe the coding policies being challenged here were lawful and proper and all parties were paid appropriately," the statement read. "Independent Health and DxID diligently navigate complex and vague coding criteria to ensure that all diagnosis and billing codes properly reflect our Members' medical conditions and are supported with documentation in the members' medical records."

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