Medicare Advantage (MA) provider HealthCare Partners Holdings has agreed to pay $270 million to resolve its False Claims Act liability after providing inaccurate information that caused MA plans to receive inflated Medicare payments, the Department of Justice announced this week.
HealthCare Partners, doing business as DaVita Medical Holdings, operated a medical service organization and contracted with MA organizations (MAOs) in states like California, Nevada and Florida, according to the DOJ. DaVita reportedly collected patient diagnosis data and submitted that information to its connected MAOs, and in turn MAOs paid DaVita a share of what they received from CMS for those beneficiaries.
DaVita voluntarily disclosed to the government that actions on behalf of HealthCare Partners caused MAOs to submit incorrect diagnosis codes to CMS and obtain inflated payments in return—payments in which DaVita and HealthCare Partners shared.
“Federal healthcare programs rely on the accuracy of information submitted by healthcare providers to ensure that managed care plans receive the appropriate compensation,” Assistant Attorney General Joseph H. 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 healthcare organizations to make voluntary disclosures to the government when they identify false claims.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.