US authorities have reached a settlement to resolve a whistleblower case alleging that a New York state health insurer systematically defrauded the federal Medicare program by exaggerating how sick members were in order to boost profits.
The settlement was disclosed in a court filing Monday that didn’t detail the settlement amount. The lawsuit in federal court in the Western District of New York concerns a type of health-care fraud claim that has drawn increasing attention from the Department of Justice.
The agreement resolves a case that began 12 years ago when the whistleblower, Teresa Ross, filed a sealed complaint alleging widespread fraud. A representative for insurer, Independent Health Corporation, didn’t have an immediate comment Monday.
The Justice Department intervened in the lawsuit in 2021, one of a series of cases that put a spotlight