Independent Health Medicare fraud resolution due to incorrect diagnoses

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 actually were to get more money from the government to get.

The government’s lawsuit submitted in 2021accused Independent Health, its now-defunct subsidiary DxID, and DxID’s former CEO, Betsy Gaffney, of systematically searching the medical records of Medicare Advantage patients for diagnoses to make money and pressuring doctors to sign it, which resulted in Independent Health receiving 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.