Elevance Health Pays $342 Million to Settle Medicare Advantage Overbilling Allegations

Elevance Health paid $342.2 million to the Centers for Medicare & Medicaid Services (CMS) on May 27, 2026, following a February 2026 threat to halt its Medicare Advantage enrollments. The payment, disclosed in a June 22, 2026 court filing, marks the first time CMS has successfully pressured a plan to return tens of millions in alleged overpayments. While Elevance Health continues to challenge the enforcement action, the payment represents a fraction of its estimated $935 million potential exposure.

Elevance $342 million payment

• ▪Elevance Health's April 2026 SEC filing estimated its potential exposure in the overbilling case at approximately $935 million
• ▪Government lawyers disclosed Elevance Health's $342 million payment in a June 22, 2026 court filing
• ▪Elevance Health paid the federal government $342,209,085.30 via wire transfer on May 27, 2026, to address Medicare Advantage overbilling allegations

Medicare Advantage overbilling practices

• ▪The United States Justice Department filed a False Claims Act lawsuit against Elevance Health, then known as Anthem, in 2020
• ▪Medicare pays Medicare Advantage plans higher rates for sicker patients but requires plans to bill only for documented conditions

CMS enrollment ban threat

• ▪The Centers for Medicare & Medicaid Services threatened in February 2026 to halt enrollments in Elevance Health's Medicare Advantage plans
• ▪The Centers for Medicare & Medicaid Services cited Elevance Health's persistent noncompliance with federal billing regulations for the threatened enrollment ban
• ▪Elevance Health is challenging the Centers for Medicare & Medicaid Services enforcement action, calling the threatened enrollment ban unprecedented

Industry-wide overpayment problem

• ▪More than 35 million Americans, representing about 55% of Medicare beneficiaries, are enrolled in private Medicare Advantage plans
• ▪Kaiser Permanente agreed to pay $556 million in January 2026 to settle Justice Department allegations of billing for non-existent medical conditions

Historical CMS enforcement failures

• ▪The Elevance Health payment marks the first time CMS successfully pressured a Medicare Advantage plan to return tens of millions in alleged overpayments
• ▪In 2014, the Centers for Medicare & Medicaid Services withdrew a proposed regulation to crack down on Medicare Advantage overbilling following industry opposition