BUFFALO, N.Y. (WIVB) -- Independent Health has agreed to pay up to $98 million to resolve allegations that it knowingly submitted invalid diagnosis codes in order to receive increased payments from Medicare.
Independent Health will pay a minimum of $34.5 million as part of the agreement.
The U.S. Attorney's Office alleged that Independent Health created a subsidiary to retrospectively search medical records and contact doctors in order to generate higher-risk scores for Medicare patients. Higher-risk scores result in higher payments through the Medicare Advantage plans for those beneficiaries.
It is alleged that from 2011 to 2017, Independent Health knowingly submitted inflated diagnoses to increase Medicare payments to Independent Health.
“To protect the integrity of Medicare and other federal health care programs, my office is committed to ensuring that each and every dollar meant for Medicare beneficiaries is spent appropriately and in accordance with the law,” said U.S. Attorney Trini E. Ross. “As this settlement makes clear, we will diligently pursue those who defraud government programs.”
“Medicare Advantage Plans that attempt to game federal programs for profit must be held accountable through rigorous oversight and enforcement,” said Christian J. Schrank, deputy inspector general of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS-OIG will continue to work with our law enforcement partners to root out fraud, waste and abuse in federal health care programs.”
In a statement, Independent Health described the assertions by the Department of Justice as allegations only.
"This settlement is not an admission of any wrongdoing," Independent Health said. "It instead allows us to avoid the further disruption, expense and uncertainty of litigation in a matter that has lingered for over a decade."
Independent Health has agreed to a five-year "corporate integrity agreement" with HHS-OIG, which will allow for an independent review of future Medicare risk-settlement submissions by the company.
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Mark Ludwiczak joined the News 4 team in 2024. He is a veteran journalist with two decades of experience in Buffalo. You can follow him online at @marklud12.
