Medicare Advantage Provider Independent Health to Pay Up To …

Dec 20, 2024  · Independent Health Association and its affiliate, Independent Health Corporation (collectively, Independent Health) have agreed to pay up to $98 million to resolve allegations that they violated the False Claims Act by knowingly submitting or causing the submission of …


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Medicare Advantage Provider Independent Health To Pay Up To …

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Dec 20, 2024  · Independent Health Association and its affiliate, Independent Health Corporation (collectively, Independent Health) have agreed to pay up to $98 million to resolve allegations that they violated the False Claims Act by knowingly submitting or causing the submission of …

justice.gov

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Medicare Advantage Provider To Pay $270 Million To Settle False …

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Oct 1, 2018  · The allegations of “one way” chart reviews were brought in a lawsuit under the qui tam, or whistleblower, provisions of the Federal False Claims Act. This statute permits private …

justice.gov

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DOJ Reaches Historic Settlement With MA Plan Independent …

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Jan 15, 2025  · The U.S. Department of Justice (DOJ) announced a settlement of up to $100 million with Independent Health, a Medicare Advantage (MA) plan serving upstate New York, …

medlearn.com

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Medicare Advantage Insurer To Pay Up To $98M To Settle False …

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Dec 23, 2024  · Independent Health will pay up to $98 million to settle allegations a now-defunct subsidiary knowingly submitted invalid diagnoses to boost Medicare Advantage payments.. …

beckerspayer.com

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DOJ Continues Medicare Advantage Enforcement Efforts

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Sep 2, 2021  · [2] Press Release, Sutter Health and Affiliates to Pay $90 Million to Settle False Claims Act Allegations of Mischarging the Medicare Advantage Program, Department of …

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Medicare Advantage - Inside The False Claims Act

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Last week, the U.S. Department of Justice (DOJ) announced a $22.4 million settlement resolving allegations that Martin’s Point Health Care, Inc. (Martin’s Point) violated the False Claims Act …

insidethefalseclaimsact.com

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Independent Health Agrees To Pay Up To $98M In Medicare Fraud …

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Dec 21, 2024  · (WNY News Now) – Independent Health Association, along with its affiliate Independent Health Corporation, has agreed to pay up to $98 million to settle allegations of …

wnynewsnow.com

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Medicare Advantage Provider To Pay $30 Million To Settle Alleged ...

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Apr 12, 2019  · “The Medicare Advantage Program provides benefits to a significant portion of federal health care beneficiaries,” said Assistant Attorney General Jody Hunt of the …

justice.gov

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Robust False Claims Act Results For DOJ In 2024 Reveal Dynamic ...

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2 days ago  · See Press Release, U.S. Dep’t of Justice, False Claims Act Settlements and Judgments Exceed $2.9B in Fiscal Year 2024 (Jan. 15, 2025). With President Donald Trump’s …

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Office Of Public Affairs | Medicare Advantage Provider …

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Dec 20, 2024  · Independent Health Association and its affiliate, Independent Health Corporation (collectively, Independent Health) have agreed to pay up to $98 million to resolve allegations …

justice.gov

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False Claims Act Enforcement Trends In Healthcare: FY 2024

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Jan 31, 2025  · An uptick, following the trend in FY 2023, of enforcement related to the Medicare Advantage (Medicare Part C) program, including a $60 million settlement and active litigation …

lexology.com

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Cigna Group To Pay $172 Million To Resolve False Claims Act …

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Sep 30, 2023  · PHILADELPHIA– United States Attorney Jacqueline C. Romero announced that the Cigna Group (“Cigna”), a national insurer with corporate offices in Philadelphia, has agreed …

justice.gov

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False Claims Act Enforcement Trends In Healthcare: FY 2024

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3 days ago  · A Florida businessman paid over $27 million to resolve allegations that he and his companies conspired with others to submit false claims to, and receive payments from, …

jdsupra.com

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Robust False Claims Act Results For DOJ In 2024 Reveal Dynamic ...

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3 days ago  · For example, in a case from the District of New Jersey, CityMD agreed to pay $12 million to resolve COVID-19 testing false claims. The allegations arose from CityMD’s failure to …

lowenstein.com

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Cigna Group To Pay $172 Million To Resolve False Claims Act …

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Sep 30, 2023  · Working with our law enforcement partners, our agency will continue to prioritize investigating alleged fraud that targets the Medicare Advantage program.” The civil settlement …

justice.gov

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Oak Street Health Agrees To Pay $60M To Resolve Alleged False …

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Sep 18, 2024  · Oak Street Health, headquartered in Chicago and a wholly-owned subsidiary of CVS Health since 2023, has agreed to pay $60 million to resolve allegations that it violated the …

justice.gov

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Office Of Public Affairs | False Claims Act Settlements And …

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Feb 22, 2024  · Settlements and judgments under the False Claims Act exceeded $2.68 billion in the fiscal year ending Sept. 30, 2023, Acting Associate Attorney General Benjamin C. Mizer …

justice.gov

FAQs about Medicare Advantage Provider Independent Health to Pay Up To … Coupon?

Can a Medicare claim be false under the False Claims Act?

A claim to Medicare may be false under the False Claims Act when the provider falsely certifies that it has complied with all relevant statutes and regulations related to the claim for payment. The certification in question must be a prerequisite to qualifying for the government reimbursement. ...

Did independent health knowingly inflate Medicare payments?

The United States filed a complaint alleging that, from 2011 through at least 2017, Independent Health, with the assistance of DxID and its founder and chief executive, Betsy Gaffney, knowingly submitted diagnoses to CMS that were not supported by the beneficiaries’ medical records in order to inflate Medicare’s payments to Independent Health. ...

Should Medicare Advantage plans be held accountable?

“Medicare Advantage Plans that attempt to game federal programs for profit must be held accountable through rigorous oversight and enforcement,” said Deputy Inspector General Christian J. Schrank of the Department of Health and Human Services Office of Inspector General (HHS-OIG). ...

What is a Medicare risk score?

The Centers for Medicare and Medicaid Services (CMS), which oversees the Medicare program, adjusts the payments to MA Plans based on demographic information and the diagnoses of each plan beneficiary. The adjustments are commonly referred to as “risk scores.” ...

What is a Medicare Advantage plan?

Under Medicare Advantage, also known as the Medicare Part C program, Medicare beneficiaries have the option of enrolling in managed care insurance plans called Medicare Advantage Plans (MA Plans). MA Plans are paid a per-person amount to provide Medicare-covered benefits to beneficiaries who enroll in one of their plans. ...

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