The Los Angeles-based AIDS Healthcare Foundation has agreed to pay $1.44 million to resolve allegations it violated the False Claims Act by submitting or failing to delete false or invalid diagnosis codes in order to increase payments that it received from the Medicare Advantage program, officials said Tuesday.
The settlement resolves allegations that, from 2017 to 2023, AHF failed to timely investigate and delete diagnosis codes that were either inaccurate or not documented in medical records, according to the U.S. Justice Department.
The claims were brought under the qui tam or whistleblower provisions of the False Claims Act by Donna Irons, a former risk adjustment coder at AHF. She will receive $259,200 as her share of the federal recovery, prosecutors said Tuesday.
“The government relies on Medicare Advantage participants to submit accurate, substantiated diagnosis codes that are adequately documented in a medical record to ensure proper payment,” Assistant Attorney General Brett A. Shumate of the DOJ’s Civil Division said in a statement. “The Justice Department will continue to protect the public and hold accountable those who receive inflated payments by knowingly providing or failing to correct false information.”
Under the Medicare Advantage Program, also known as Medicare Part C, Medicare beneficiaries may opt out of traditional Medicare and enroll in private health plans offered by insurance companies known as Medicare Advantage Organizations, or MAOs.
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AIDS Healthcare Foundation will pay $1.44 million to resolve allegations that it violated federal law by submitting false or invalid codes to inflate payments from the Medicare Advantage program. ...