Aetna settles Medicare Advantage False Claims case for $117.7 million

Aetna has agreed to pay $117.7 million to settle Department of Justice allegations it submitted false claims to the Medicare Advantage program. The settlement resolves claims that the insurer inflated risk-adjustment payments by submitting inaccurate diagnosis data. This enforcement action signals continued DOJ and OIG scrutiny of Medicare Advantage coding and risk-adjustment practices, which can indirectly affect provider groups through payer audit and documentation review pressures. While not a direct action item for independent practices, it underscores the regulatory environment in which payers operate and may lead to more stringent chart reviews.