Medicare Advantage Insurer Agrees to Pay

The Centers for Medicare & Medicaid Services (CMS) uses a complex formula that pays health plans higher rates for sicker patients and less for people in good health. Health plans must retain medical records that document all diagnoses they highlight for reimbursement. According to a settlement agreement, Independent Health Association of Buffalo, which operates two Medicare Advantage plans, will pay up to $98 million. Betsy Gaffney, CEO of medical records review company DxID, will pay $2 million. Independent Health billed Medicare for a range of medical conditions that either were exaggerated or not supported by patient medical files, according to the complaint. Read a story from KFF Health News.

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