has agreed to pay $1.5 million to the federal government to settle potential civil complaints that one of its divisions altered Medicare files and claims information from 1992 through 1994 to improve its performance evaluation as a Medicare contractor.
U.S. Attorney Mary Beth Buchanan and Assistant Attorney General Peter D. Keisler, head of the Justice Department civil division, said the settlement resolves allegations that employees of Highmark's Veritus Medicare Services in Pittsburgh tampered with the files to boost the division's scores in a government review.
The case is separate from a Justice Department complaint filed last year in Philadelphia alleging that Highmark misapplied Medicare rules to avoid paying insurance claims and instead passed them on to the government.
That complaint, which started as a whistleblower suit in 2000, is pending in the Eastern District of Pennsylvania.
The current settlement resulted from information Highmark gave to the Justice Department, Buchanan and Keisler said.
Highmark spokesman Michael Weinstein said the company uncovered irregularities in 2001 in the Veritus division, which processes Medicare claims for the government.
He said the problems were discovered during an internal investigation of the other complaint, which was originally filed by employee Elizabeth Drescher in 2000 and joined by the Justice Department last year.
The $1.5 million settlement is another in a series of payments by Highmark related to Medicare claims.
In 1995, Highmark and 62 other Blue Cross and Blue Shield plans paid $27 million to settle allegations that they misapplied Medicare eligibility rules to shift costs to the federal government. Highmark paid $6 million of that total.
In 1998, Highmark paid another $38.5 million to settle claims that its corporate predecessor, Pennsylvania Blue Shield, violated the False Claims Act by obstructing Medicare audits of the company's performance as a Medicare contractor and failed to properly process claims or recover overpayments.
First Published: April 22, 2004, 4:00 a.m.