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Anthem is heading to court (again)

The adage is true: You can’t teach an old dog new tricks. Or an old insurer with a new name.

The artist formerly known as ‘Anthem’ can’t escape its legal woes.

You may remember back in 2020 when the health insurer paid $594 million toward the Blue Cross Blue Shield Association antitrust settlement. Filed in 2012, the suit was a moment of reckoning for Anthem and its Blues affiliates, accused of trying to minimize competition by dividing geographic regions amongst themselves and driving consumer costs up. Eight years later, it was time for Anthem to pay up. And they did. Then, they rebranded – as Elevance.

But it turns out a name change can’t solve all your problems – the insurance company is back in the federal crosshairs yet again.

According to an October 4th article in Modern Healthcare, the Justice Department is suing Anthem because “the Medicare Advantage insurer. . . fraudulently collect[ed] more than $100 million in overpayments.” If allegations are true, Anthem’s behavior took place between 2014 and 2018 (after the antitrust suit was filed, for what it’s worth), and the suit alleges the insurer scanned “Medicare Advantage members’ medical charts to find as many diagnosis codes as possible to submit to CMS…. In the process, the insurer chose not to delete thousands of inaccurate diagnosis codes listed because that would have reduced its revenue through the program, the complaint alleges,” per Modern Healthcare.

Ah yes, this is exactly the kind of behavior we want to see from one of the nation’s largest health insurers. Scratch that, potentially the nation’s largest insurer, per the company’s most recent earnings call.

Anthem filed to dismiss the case, which was denied (thankfully!) so now it’s up to the judge if the company faces justice. And if Anthem is found guilty or settles without admitting guilt (as insurance companies seemingly love to do), the next question is whether the fee will be costly enough to deter this bad behavior.

Or will it be just another slap on the wrist?

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