A health care provider has agreed to pay $2.4 million to resolve allegations that it violated the False Claims Act by causing the submission of false diagnosis codes to increase payments under the Medicare Advantage program, officials announced Monday in Los Angeles.
Tennessee-based Monogram Health is a multi-specialty provider of in-home care for patients with multiple chronic conditions.
The settlement resolves allegations that from 2021 through 2023, Monogram knowingly submitted diagnosis codes that were not clinically accurate, not supported by documentation in the beneficiary’s medical records, and/or did not require or affect patient care, treatment or management, federal prosecutors said.
The submission of the diagnosis codes resulted in false claims that inflated the risk scores of Medicare Advantage beneficiaries, thereby causing the Centers for Medicare & Medicaid Services to make higher payments to the company than it would have paid without the diagnosis codes.
The civil settlement filed in Los Angeles federal court includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Dr. Ajay Gupta, a physician formerly employed by Monogram.
“When it comes to how federal money is being spent, taxpayers deserve to know that this Justice Department is looking out for them,” First Assistant U.S. Attorney Bill Essayli said in a statement. “My office will continue to work to ensure that money for public health...
A health care provider has agreed to pay $2.4 million to resolve allegations that it violated the False Claims Act by causing the submission of false diagnosis codes to increase payments under the ...