Aetna to pay $117.7 million to settle Medicare Advantage false claims allegations

Aetna has agreed to pay $117.7 million to settle allegations that its Medicare Advantage plans submitted false risk-adjustment claims. The settlement resolves a whistleblower case and signals continued DOJ and OIG scrutiny of MA coding and chart reviews. The case originated from a qui tam complaint alleging the insurer's vendors inflated risk scores by adding unsupported or unverified diagnoses to patient charts. For independent practices, this reinforces the importance of accurate documentation, especially for MA beneficiaries. Payers will likely tighten their own audit processes in response, which could lead to more aggressive recoupment efforts. Monitor your internal documentation quality for MA patients and prepare for potential payer audits as the industry-wide focus on risk adjustment intensifies.