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Anthem Blue Cross, Health Net accused of violating False Claims Act

March 20, 2018 Mental Health


Anthem Blue Cross, Health Net accused of violating False Claims Act

Big players in America’s health insurance industry are not strangers to lawsuits and penalties for a wide range of reasons. In recent years, several insurance companies have been under siege for withholding payments to drug rehab centers for months under the pretext of investigating fraudulent claims. Now, a former medical data contractor worker has accused several insurers, including Health Net and Anthem Blue Cross, of violating the False Claims Act (FCA), according to the United States Court of Appeals for the Ninth Circuit.

According to Anita Silingo, a former employee of MedXM, these insurers submitted inflated data on health assessment to the government. However, the insurance firms maintained that the lawsuit failed to back the allegations with specific evidence. Silingo alleged that both Health Net and Anthem contracted MedXM for in-home health assessments by including exaggerated data to increase business with her former employer. The exaggerated data was later submitted to the Centers for Medicare & Medicaid Services (CMS) for reimbursement.

The defendants have appealed to reverse Silingo’s complaint as she failed to plead the allegations properly. Therefore, she was also prevented from filing a fourth amended complaint. However, Silingo’s attorney Abram Zinberg argued that his client’s case included several facts to demonstrate that the health plans submitted false data intentionally. Zinberg said that risk adjustment data sent to the government mandates proper documentation to support the medical records.

Speaking on behalf of the insurers, David Leviss of O’Melveny and Myers LLP stated that the whole case is a “straightforward” dismissal. Silingo didn’t mention the “who, what, when, where” in the lawsuit, which is very important for the case to become relevant, Leviss said. In August 2013, Silingo first presented her case under seal as a relator. The government had earlier declined to intervene in the case, resulting in the unsealing of a previously amended complaint.

Several health insurers across the U.S. have been found denying coverage for mental health treatment. However, the law doesn’t allow for the same. According to the 2008 Mental Health Parity and Addiction Equity Act, mental health and substance abuse treatment claims should be covered on par with surgical or medical procedures. So, any discrimination by insurers is a clear violation of the landmark federal law.

Mental health problems are treatable

In the wake of the existing broken health care system, experts are concerned about the negative impact on health coverage across the U.S., particularly in the field of mental health. According to the 2017 report of Mental Health America (MHA), more than 40 million Americans nationwide – exceeding the combined population of Florida and New York — struggle with a mental health disorder. Studies suggest more than 56 percent of adults battling mental health problems still do not have access to any kind of professional help or treatment.

Emotional or behavioral disorders have become one of the most difficult challenges across the country. The National Alliance on Mental Illness (NAMI) reports that at least one in 25 American adults grapples with a serious mental health problem, affecting their important life activities. Striving to deal with emotional upheavals that seem beyond one’s control can be an enervating experience and a formidable challenge. However, professional support to fight such conditions can help in eliminating an unending cycle of futile treatments.

If you or your loved one is battling mental health disorders, contact the Recover Mental Health now. Our representatives can give you all the information about the best inpatient mental health treatment centers in your vicinity. Call us at our 24/7 helpline number 866-593-2339 or chat online with one of our experts to know more about world-class inpatient mental health facilities near you.

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