The FBI is investigating Zoom Health Plans over allegations the payer retroactively filed false medical claims to avoid having to pay $3 million into an ACA program, the Portland Business Journal reports.
Here's what you should know:
1. A former employee revealed the claims to the Business Journal on the condition of anonymity.
2. According to the employee, Zoom CEO Dave Sanders, MD, was unhappy after he learned the payer would have to pay into the federal government's risk adjustment program because it had not spent enough on medical claims.
3. The FBI filed a subpoena on June 12. Investigators are looking into the alleged fraud.
4. Zoom Health also possibly fired several employees recently.
5. A Zoom spokesman confirmed to the Business Journal several staff members were questioned by FBI investigators. He declined to comment on the ex-employee's allegations.