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Thursday, March 28, 2024

Medicare Advantage provider to pay $2.7 million over alleged False Claim Act violations

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WASHINGTON, D.C. — A California-based Medicare Advantage provider has reached a $270 million settlement with the federal government over charges of violating the False Claims Act. 

According to the U.S. Department of Justice (DOJ), DaVita Medical Holdings LLC voluntarily disclosed that through a physician association it acquired in 2012, HealthCare Partners, submitted and collected inaccurate diagnosis codes to Medicare Advantage Organizations (MAOs) and obtained inflated payments. 

“Federal health care programs rely on the accuracy of information submitted by health care providers to ensure that managed care plans receive the appropriate compensation,” DOJ Civil Division assistant attorney general Joseph Hunt said in a statement.  “We will pursue those who undermine the integrity of the Medicare program and the data it relies upon. This also illustrates that the department encourages and incentivizes health care organizations to make voluntary disclosures to the government when they identify false claims.” 


“This case involved illegal conduct in which patients’ medical conditions were improperly reported and were not corrected after further review – all for the purpose of boosting the bottom line," added U.S. attorney Nick Hanna. 

The settlement also resolves a lawsuit by a whistleblower that alleged HealthCare Partners scoured its patients' medical records for any "missed diagnosis" providers may have not recorded during "one-way" chat reviews. The company then submitted the "missed diagnosis" to MAOs to increase Medicare payments, the Justice Department said.

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