The watchdog said the payer submitted documentation that inaccurately showed some of its Medicare Advantage members were sicker than they actually were.| Healthcare Dive
The payer said it plans to vigorously defend its practices as the lawsuit alleges it put profits ahead of compliance.| Healthcare Dive
The payer used a medical assessment program to find health conditions that could raise risk scores of plan members, offering incentives to physicians who gave the exam, according to the lawsuit.| Healthcare Dive
Lagging vaccination rates lead the company to expect the pandemic to be a "modest negative for 2021," CFO Shawn Guertin said. Previously, it expected COVID-19 to have little to no impact on full-year earnings.| Healthcare Dive
The insurer is the latest to face allegations of receiving Medicare Advantage overpayments tied to patients who were inaccurately identified as part of a high-risk group.| Healthcare Dive
Attempts to "defraud the program cannot continue and will be pursued," DOJ officials said in statement announcing the action against the California-based system.| Healthcare Dive