Anthem Lawsuits Continue in 2023
Summary:
The US Government believes Anthem has fraudulently collected millions in overpayments from Medicare. We quickly review what the general public is privy to.
The $12 Billion Coding Dilemma
The first accusation is that Anthem was not correctly reviewing Diagnosis codes which resulted in over $100 million in overpaid annual Medicare Advantage claims for four years straight, but is part of a larger $12 billion coding dilemma the US Healthcare System continues to overlook (link).
Codes and Medicare Advantage Enrollment Continue to Grow
Based on the current ICD-10 Codes there are 71,924 procedure codes and 68,823 diagnosis codes. Nearly 48% of the eligible Medicare population is now under a Medicare Advantage Plan and has an average of 38 different Medicare Advantage Plans to choose from (link). Common sense tell us that there is just an impossible number of codes and plans with exclusions/contracts/and special calculations human errror. The solution we need is automation and AI technology to which PCG has made the flagship offering on for over 30 years. We hope that more people listen and realize the solution is out there.
Valley Health Files Suit
Valley Health System has filed a suit against Anthem Blue Cross Blue Shield (Elevance) claiming they have been underpaid $11.4 million dollars throughout COVID (link). This suit is still ongoing and we’ll report back to you with updates.
Anthem Earnings and Breakdown
You may be unaware but Anthem has undergone a rebranding and sometime in 2023 or 2023 shall be known as Elevance, but we’ll keep them named in our blog as “Anthem” to make it easier. Anthem is set to see a projected 2023 increase of 8.5% in revenue due to their Medicare Advantage Plans backed by Anthem’s decision to increase rates by 4.88%. (link).
SUMMARY:
Anthem is under fire and they have some decisions to make as they head in 2023 projecting larger earning with legal cases sitting in their to-do box. We hope that all parties involved can find a more simpler automated process to ensure that doctors and hospitals are paid fairly to ensure they don't increase the already growing trend of healthcare turnover and delays of treatment. Likewise, we hope that if there is fraud, waste, or abuse coming from the hospitals and providers that they are held accountable to remain up to date on proper coding and billing practices to avoid this avalanche of delayed and incorrect billing to occur.
Our History and Credibility in Reporting this Information:
For over 30 years, PCG Software Inc. has been a leader in AI-powered medical coding solutions, helping Health Plans, MSOs, IPAs, TPAs, and Health Systems save millions annually by reducing costs, fraud, waste, abuse, and improving claims and compliance department efficiencies. Our innovative software solutions include Virtual Examiner® for Payers, VEWS™ for Payers and Billing Software integrations, and iVECoder® for clinics.
