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western New York health insurance providerKFF Health News
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80% Informative
Independent Health Association of Buffalo , which operates two Medicare Advantage plans, will pay up to $98 million .
Betsy Gaffney , CEO of medical records review company DxID, to pay $2 million , according to the settlement agreement.
Neither admitted wrongdoing.
The settlement is the largest by a health plan based solely on a whistleblower's fraud allegations.
Whistleblowers sue under the False Claims Act , a federal law dating to the Civil War that allows private citizens to expose fraud against the government.
At least two dozen such suits have targeted Medicare Advantage plans for overstating the severity of medical conditions.
CMS has done little to recoup money for the U.S. Treasury .
VR Score
82
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81
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41
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English
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