Independence Blue Cross Pays $22.5M to Settle MA Fraud Claims
Independence Blue Cross agreed to pay $22.5 million to resolve allegations that it inflated diagnosis codes for Medicare Advantage beneficiaries to boost risk-adjustment payments. The insurer described the settlement, along with similar resolutions by other payers, as reflecting "industry-wide challenges" in applying Medicare Advantage risk adjustment standards. The matter concerns Medicare Advantage rather than Medicaid managed care directly, though risk adjustment practices and enforcement scrutiny often extend across both program types for payers operating in both markets.
Health plans operating both Medicare Advantage and Medicaid managed care lines should expect continued scrutiny of risk adjustment and diagnosis coding practices across their business, given enforcement attention on coding accuracy.
Finance
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