Coventry forks over $3M to avoid criminal prosecution

Coventry Health Care has agreed to pay $3 million to the federal government to avoid criminal prosecution regarding its unauthorized access of a federal Medicare database.

According to the Maryland U.S. Attorney's Office, Coventry employees "inappropriately accessed" records in a database of Medicare members from 2005 to 2006 to determine eligibility status of worker's compensation claimants, reported Business Insurance.

The unauthorized access was "intended in part to give Coventry an unfair advantage over its competitors" so it could sell the claimants Medicare set-aside products that allocate worker's comp settlement funds to pay Medicare members' future medical costs, the attorney's office said in a statement.

What's more, Coventry's top officials, including its senior vice president for worker's comp services, knew the employees were improperly using the database, yet didn't stop the access until the Centers for Medicare & Medicaid Services raised concerns, The Baltimore Sun reported.

Coventry also agreed to hold regular employee training to discuss appropriate database use.The insurer said "the conduct by these employees was a violation of company policy, and Coventry has put several new measures, controls, policies and trainings into place to prevent violations in the future," the Sun noted.

To learn more:
- here's the U.S. Attorney's statement
- read the Baltimore Sun article
- see the Business Insurance article

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