WASHINGTON/NEW YORK, March 11 (Reuters) – Aetna, a unit of CVS Health, agreed to pay $117.7 million to resolve U.S. government charges it violated the federal False Claims Act by submitting incorrect diagnosis codes for Medicare Advantage Plan enrollees, in order to increase its payments from Medicare.
The settlement was announced by the U.S. Department of Justice on Wednesday.
Under Medicare Advantage, also known as Medicare Part C, patients who opt out of traditional Medicare may enroll in private health plans known as Medicare Advantage Organizations.
The Justice Department said Aetna submitted inaccurate patient data to the Centers for Medicare & Medicaid Services to inflate risk adjustment payments it received, and falsely certified in writing that the data were truthful.
CVS did not immediately respond to requests for comment.
(Reporting by Jonthan Stempel in New York; Additional reporting by Susan Heavey and Bhargav Acharya; Editing by Ryan Patrick Jones and Chizu Nomiyama)
