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The Office of the Inspector General has released a report that raises questions about whether Medicare Advantage plans have inappropriately denied claims to increase profits.

Although it did not name specific plans, the OIG report is based on appeals to MA denials and the outcomes. MA organizations overturned 75 percent, amounting to 216,000 denials, from 2014 to 2016. Independent reviews at higher levels overturned an additional 80,000 denials during those two years in favor of the beneficiaries and providers, the report said.

The report did not give a comparison of...

Health insurer Anthem has refused to comply with the U.S. Justice Department's investigation into its Medicare Advantage billing practices, according to federal court documents filed Tuesday.

So the Justice Department this week asked the U.S. District Court for the Southern District of New York to force Anthem to comply with a civil investigative demand issued in March to provide testimony about its chart review and risk-adjustment program for its Medicare Advantage plans.

The Justice Department initially demanded the testimony by April 13 but said Anthem has yet...

In 2017, insurance company Anthem, Inc. began implementing new medical coverage policies that affect emergency services and medical imaging. As to the former, Anthem’s new policy allows it to reduce coverage for emergency services provided if Anthem later determines that the situation giving rise to the services was not, after all, an emergency. As to the latter, Anthem is denying certain claims for medical imaging performed at hospitals rather than at clinics. In March of this year, Senators Claire McCaskill (D-Mo.) and Ben Cardin (D-Md.) sent a letter to the Depa...

The Justice Department has sued UnitedHealth Group, saying that senior executives knew the company was overbilling Medicare by hundreds of millions of dollars a year, and halted a repayment plan in 2014 so the money could be used to meet Wall Street’s revenue expectations.

In a complaint filed Tuesday in United States District Court in Los Angeles, the Justice Department said UnitedHealth routinely combed through millions of patients’ medical charts, searching for data it could use to make patients look sicker than they really were, in what the lawsuit called “stric...

Federal prosecutors slapped a multi-billion dollar Medicare fraud charge against United Health Group (UHG) and a key subsidiary President Barack Obama’s former top insurance official once headed, according to an investigation by The Daily Caller News Foundation.

It was the third time health fraud charges have been filed against United and its two major subsidiaries, Optum and OptumInsight.

United spokesman Matthew Burns denied the allegations, saying in a statement, “We reject these more than 5-year-old claims and will contest them vigorously.”

Andy Slavitt, who led t...

Cigna Corp. has been banned from marketing its Medicare products to new customers after the U.S. found deficiencies in how the health insurer ran its plans, citing widespread violations that the government said threatened patients’ health.

“Cigna has experienced widespread and systemic failures impacting Cigna enrollees’ ability to access medical services and prescription medications,” the U.S. government said in a Jan. 21 letter to the insurer outlining the sanctions. “Cigna has had a longstanding history of noncompliance” with requirements from the Centers for Med...

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