The U.S. Department of Justice has reached a $541.5 settlement with a Florida health care provider over alleged False Claims Act violations.
The agency alleged that The Villages Health System, based in the 55-plus community of The Villages in central Florida, submitted false diagnosis codes to increase payments from the Medicare Advantage program. More than 83,000 people live in The Villages, with a median age of 74.
"The Medicare Advantage program relies on accurate diagnoses to protect the federal fisc," Assistant Attorney General Brett A. Shumate of the Justice Department's Civil Division said in a news release. "Today's settlement reflects that we will hold accountable entities that inflate payments through invalid diagnoses; at the same time, we will continue to credit organizations that disclose wrongdoing, take appropriate remedial actions and fully cooperate with the government's investigation."
Enrollees are allowed to opt out of traditional Medicare and instead enroll in private health plans offered by insurance companies known as Medicare Advantage Organizations, or MAOs. These organizations are paid a fixed monthly amount for each Medicare enrolled in their plans. Each month, the Centers for Medicare & Medicaid Services adjusts payments based on certain risk factors that affect expected expenditures.
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