A New York health insurer and one of its former executives have agreed to pay the Justice Department up to $100 million to resolve claims that they made their Medicare members appear sicker than they really were to get more money from the government.
The government’s lawsuit, filed in 2021, accused Independent Health, its now defunct subsidiary DxID, and DxID’s former CEO, Betsy Gaffney, of systematically scouring Medicare Advantage patients’ medical records for money-making diagnoses and pressuring doctors to sign off on them, resulting in Independent Health getting millions more from the government than it otherwise would have.
The government has sued many insurers for Medicare Advantage fraud, but this was the first time such a lawsuit also targeted the vendor at the center of the scheme.
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