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An older woman gets a checkup at home. Photo: Jahi Chikwendiu/The Washington Post via Getty Images

Dialysis chain DaVita this week agreed to pay $270 million to settle allegations that physicians in its medical group fudged how sick their patients were so they could get paid more from Medicare Advantage plans — which in turn got higher payments from the federal government.

Why it matters: DaVita's settlement eliminates a three-year-old probe. But the entire Medicare Advantage industry — estimated to cost the federal government $250 billion in 2019 — remains under the microscope for gaming the payment system.

What's next: The Department of Justice is continuing its investigation of the coding practices of the largest health insurance companies in the country.

  • Aetna, Anthem, Centene, Cigna, Humana and UnitedHealth Group have disclosed to investors in quarterly securities filings that DOJ is probing their "risk adjustment practices" as part of a "wider review of Medicare risk adjustment generally that includes a number of Medicare Advantage plans, providers and vendors."
  • UnitedHealth also is battling a whistleblower lawsuit that alleges the insurer went through patient medical records and purposely exaggerated diagnoses. UnitedHealth says the lawsuit has no merit and says federal rules have been unclear.
  • DaVita's settlement covers allegations it not only looked back and submitted diagnosis codes that could not be supported medically, but also did not delete unsubstantiated codes.
  • Coincidentally, DaVita is selling the physician group involved in the settlement to UnitedHealth. Federal antitrust regulators are still reviewing the deal.

How it works: Health insurers that sell Medicare Advantage plans assign "risk scores" to their members, based on the health conditions they have. The higher the risk score, the more conditions someone has, and the more money the insurer gets for covering them.

  • Yes, but: Research and reporting have found payments to Medicare Advantage plans "exceed what is warranted" because of the industry's aggressive, yet technically legal, medical record coding.

The big picture: The federal government expects more than 22 million seniors and disabled people, or about 37% of all Medicare enrollees, to be in a Medicare Advantage plan next year. Wall Street predicts half of all Medicare beneficiaries will be in Medicare Advantage by 2021.

  • Growth in the program won't wash away concerns about coding. Pending whistleblower suits allege Medicare Advantage insurers and coding vendors aggressively document patients' health statuses during home visits.

Go deeper

Updated 2 hours ago - Sports

Swimmer Chase Kalisz first American to win Tokyo Olympics gold medal

Chase Kalisz of Team United States celebrates after winning the Men's 400m Individual Medley Final on day two of the Tokyo 2020 Olympic Games at Tokyo Aquatics Centre in Tokyo, Japan. Photo: Al Bello/Getty Images

Swimmer Chase Kalisz has become the first Team United States Olympian to win gold at the Tokyo Games.

The big picture: The Rio 2016 silver medalist's winning time in the men's 400 meters Individual Medley Final was 4 minutes 9.42 seconds. His teammate Jay Litherland took silver, .86 seconds behind him. Moments later, Kieran Smith grabbed a third medal for the U.S. when he won bronze in the 400-meter freestyle.

Go deeper: Full Axios coverage

Editor's note: This article has been updated with new details throughout.

3 hours ago - Sports

Gymnast Suni Lee to make historic debut at Olympics

USA's Sunisa Lee performs at the FIG Artistic Gymnastics World Championships in Stuttgart, Germany, on Oct. 13, 2019. Photo: Lionel Bonaventure/AFP via Getty Images

When Sunisa "Suni" Lee steps up to the mat at the Tokyo Olympics, she'll be thinking of her father's pep talks even as he watches from thousands of miles away.

The big picture: The 18-year-old made history this year when she became the first Hmong American to be named to a U.S. Olympic team. Even more special was her dad's presence in the crowd at the Olympic trials — it was only the second time he watched her compete in person since a 2019 accident paralyzed him from the chest down.

DOJ won't investigate nursing home deaths in N.Y. and 2 other states

People who've lost loved ones due to COVID-19 while they were in New York nursing homes attend a March protest and vigil in New York City. As of this month, Photo: Spencer Platt/Getty Images

The Department of Justice has decided not to launch a civil rights investigation into whether policies in New York, Pennsylvania and Michigan contributed to pandemic deaths in nursing homes, according to a letter sent to Republicans.

Why it matters: The Trump DOJ requested data from the three states plus New Jersey last August "amid still-unanswered questions about whether some states, especially New York, inadvertently worsened the pandemic death toll by requiring nursing homes to accept residents previously hospitalized for COVID-19," per AP.