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Independence Blue Cross to pay $22.5M to resolve MA fraud allegations – Healthcare Dive
Dive Brief:
- Philadelphia-based insurer Independence Blue Cross has agreed to pay $22.5 million to settle allegations it defrauded Medicare by knowingly submitting inflated diagnosis codes in Medicare Advantage, the Department of Justice announced Wednesday.
- The DOJ contends that the diagnosis codes made patients appear sicker than they actually were, a process called upcoding. As a result, the insurer allegedly received higher payments from Medicare than it was entitled to.
- IBX said it settled the case to avoid prolonged litigation, but did not admit wrongdoing. “This matter was not about the quality of care our members received. It involved differing views regarding certain documentation and reporting requirements under…
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