Aetna Inc., a national insurer owned by CVS Health, has agreed to pay $117.7 million to settle a case alleging that it had violated the False Claims Act, swindling Medicare out of millions of dollars by submitting inflated or inaccurate diagnosis codes for its Medicare Advantage Plan recipients.
According to a March 11 statement from the Department of Justice (DOJ), the Hartford, Connecticut-based insurer had been accused of inflating patient-diagnosis data to the Centers for Medicare & Medicaid Services (CMS) to receive higher payments. Aetna was also accused of falsely certifying to the CMS that the data were accurate.
