News Briefs

✦ A new lawsuit filed by the U.S. Attorney for the Southern District of New York accuses Anthem, Inc. of bilking the federal government out of millions of dollars through a one-sided chart review program. The civil fraud action (U.S. v. Anthem, Inc., 1:20-cv-02593) alleges that while conducting chart reviews aimed at identifying additional diagnosis codes for obtaining risk adjusted payment through the Medicare Advantage program from 2014 to 2018, the insurer neglected “its duty to delete thousands of inaccurate diagnoses” and “often generated $100 million or more a year in additional revenue” as a result. UnitedHealth Group was the subject of similar allegations in two separate whistleblower suits; the Justice Dept. in 2017 intervened in both but has since dropped one. View the complaint at https://go.aws/3axP1qP.

✦ As states pursue 1135 waivers to expand access to their Medicaid programs during the COVID-19 outbreak, CMS on March 24 withdrew a proposed rule that would have allowed states to tighten their Medicaid eligibility determinations, Modern Healthcare reports. The proposed rule was scheduled to publish in April, according to www.reginfo.gov. CMS as of March 31 had approved 38 waivers allowing states to make various modifications to their Medicaid programs in response to the outbreak. These approvals include the ability to quickly enroll out-of-state or new providers and temporarily suspend prior authorization requirements. Visit https://go.cms.gov/39zDSEt.

© 2021 MMIT

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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