Medicare Advantage Insurer and CEO to Settle Fraud Case for Up to $100M

A western New York health insurance provider for seniors and the CEO of its medical analytics arm have agreed to pay up to $100 million to settle Justice Department allegations of fraudulent billing for health conditions that were exaggerated or didn’t exist.

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, will pay $2 million, according to the settlement agreement. Neither admitted wrongdoing.

Read more at Daily Breeze.