Two long-running, not-for-profit Medicare Advantage plans and their affiliates are preparing to defend against allegations of “upcoding” in a recently unsealed False Claims Act (FCA) lawsuit. Initially filed in a federal court in 2012, the qui tam complaint alleges that Seattle-based Group Health Cooperative (GHC) and its vendor partner DxID (a subsidiary of Buffalo, N.Y.-based MA plan operator Independent Health) engaged in a deliberate scheme that resulted in the submission of thousands of fraudulent claims to the U.S. government for risk-adjusted payments worth millions of dollars.
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