News: DOJ files complaint in False Claims Act suit against data mining company

Independent Health and DxID violated the False Claims Act by submitting inaccurate information about Medicare Advantage plan beneficiaries’ health status in order to increase reimbursement, according to a Department of Justice (DOJ) complaint.

The two parties “knowingly swindled the government out of tens of millions of dollars,” the DOJ alleges, specifically calling out the DxID data mining company for its part in allegedly submitting thousands of unsupported medical condition codes on behalf of Independent Health.

According to the complaint, DxID retroactively combined electronic health records to identify missed diagnoses and asked providers to sign addenda forms up to a year after the patient visit. They then used those addenda to justify adding risk-adjusting diagnoses that were not present or documented during the patient visit. Once Independent Health became aware of the unsupported diagnosis codes, it did not take corrective action.

Independent health and DxID deny all allegations of wrongdoing in the lawsuit, and a spokesperson for the companies said they will continue to defend themselves in court.

This suit continues the recent string of government crackdowns on fraud in the Medicare Advantage program.

Editor’s note: The DOJ press release can be found here. HealthcareDive’s coverage of this story can be found here. More ACDIS coverage of the Medicare Advantage fraud crackdowns can be found here.