Aetna Pays $117.7 Million to Resolve Medicare Advantage Coding Allegations
TL;DR Summary
Aetna will pay $117.7 million to settle False Claims Act allegations that it submitted or failed to withdraw inaccurate diagnosis codes to inflate Medicare Advantage payments, including morbid obesity codes for 2018–2023, and related issues from a 2015 chart-review program; a whistleblower, a former Aetna risk-adjustment coder, will receive about $2.01 million. The case was pursued by the DOJ Civil Division, Fraud Section, and HHS-OIG with the U.S. Attorney’s Office for the Eastern District of Pennsylvania.
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