CVS Health's Aetna unit has agreed to pay $117.7 million to resolve False Claims Act allegations, the Justice Department announced. The settlement addresses claims that Aetna submitted false patient diagnosis data for Medicare Advantage Plan enrollees to receive higher monthly payments from the Centers for Medicare and Medicaid Services.

The allegations centered on Medicare Advantage billing practices, where accurate patient diagnoses directly impact reimbursement rates. Federal investigators alleged Aetna manipulated diagnosis codes to inflate patient risk scores, resulting in inflated government payments. This type of fraud undermines the integrity of Medicare's payment system and increases costs for taxpayers.

The settlement follows a pattern of enforcement actions against Medicare Advantage insurers accused of similar billing irregularities. While Aetna did not admit wrongdoing as part of the agreement, the substantial payment reflects the government's commitment to pursuing healthcare fraud cases that target federal health programs.