DOJ investigating Anthem’s Medicare Advantage, Part D plans

anthem
Anthem recieved a second request from the DOJ in March as part of a wider investigation into Medicare Advantage and Part D plans. (Matthew Hurst / CC BY-SA 2.0)

The Department of Justice has asked Anthem for more information about its Medicare Advantage and Part D plans as part of an ongoing probe dating back to 2016.

The DOJ issued a civil investigative demand to Anthem in March asking for additional information about the company’s “chart review and risk adjustment programs under Parts C and D of the Medicare Program,” according to a Securities and Exchange Commission filing on Wednesday.

Anthem says the inquiry is part of a broader investigation that includes other Medicare Advantage health plans, as well as providers and vendors.

RELATED: Fraud and billing mistakes cost Medicare—and taxpayers—tens of billions last year

It marks the second time in almost as many years that the DOJ has inquired about the company’s Medicare Advantage plans. Anthem received a similar civil investigative demand in December 2016.

“We continue to cooperate with the DOJ’s investigations, the ultimate outcome of the DOJ's investigation cannot presently be determined,” the company wrote in its filing.

Anthem did not return a request for comment.

Medicare Advantage fraud has been in the DOJ’s crosshairs for several years as prosecutors mounted several high-profile cases, including two whistleblower cases against UnitedHealthcare alleging the insurers inflated MA risk scores led to fraudulent payments.

RELATED: DOJ abandons Medicare fraud suit against UnitedHealth

Both of those case have fizzled out, however. DOJ abandoned one case in October and declined to strengthen its arguments in another after a judge dismissed some of the government’s claims against UnitedHealth.

Other insurers have been swept up in the DOJ’s probe. In court documents filed in May of last year, federal prosecutors indicated they were conducting ongoing indications of Health Net, Aetna, Humana and Cigna’s Bravo Health.

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