AIDS Healthcare Foundation (AHF), a Los Angeles, California-based nonprofit organization, has agreed to pay $1.44 million to resolve allegations that it violated the False Claims Act by submitting or failing to delete false or unsupported diagnosis codes to increase payments received through the Medicare Advantage program.
The allegations concern payment years 2017 through 2023 and AHF’s Managed Care Division, doing business as Positive Healthcare Partners, which operated Medicare Advantage special needs plans for HIV patients in Florida, Georgia, and California.
The United States alleged that AHF failed to timely investigate and delete diagnosis codes that were inaccurate or not supported by beneficiaries’ medical records. The settlement also resolves a whistleblower lawsuit brought by former AHF risk adjustment coder Donna Irons, who will receive $259,200 from the federal recovery.
| Key detail | Information |
|---|---|
| Organization | AIDS Healthcare Foundation (AHF) |
| Location | Los Angeles, California |
| Settlement amount | $1.44 million |
| Law involved | False Claims Act |
| Program | Medicare Advantage / Medicare Part C |
| Payment years | 2017–2023 |
| Managed care division | Positive Healthcare Partners |
| Alleged conduct | Submission or failure to delete inaccurate or unsupported diagnosis codes |
| Whistleblower | Donna Irons, former AHF risk adjustment coder |
| Whistleblower share | $259,200 |
| Federal agencies | DOJ Civil Division, Commercial Litigation Branch,... |
US Secretary of State Marco Rubio has sharply rejected Volodymyr Zelensky’s claims that Washington has slowed intelligence and battlefield support to Ukraine, insisting there has been no pause in ...