Anthem Must Face Feds’ Medicare Fraud Suit in New York Court (1)

Federal prosecutors may advance their False Claims Act suit alleging that Anthem Inc. failed to ensure the accuracy of risk adjustment diagnosis data that it submitted to the Centers for Medicare and Medicaid Services.

Anthem failed to show that the suit should be dismissed for lack of materiality, which concerns whether compliance with a requirement affects payment by the government, Judge Andrew L. Carter of the US District Court for the Southern District of New York said in a Friday opinion.

The complaint lacks allegations that the government had actual knowledge of noncompliance with regulations, and therefore acquiesced to fraud, ...