LOS ANGELES — AIDS Healthcare Foundation, a Los Angeles-based nonprofit, was accused of inflating Medicare payments with unsupported diagnosis codes before agreeing to a $1.44 million federal settlement.
The settlement agreement says AHF coders began maintaining “Delete Research” spreadsheets around 2017, tracking diagnosis codes that appeared unsupported by patients’ medical records but needed further investigation.
The Justice Department alleged AHF knew it had 60 days to investigate and delete unsupported codes, but did not remove most of those in the spreadsheets until 2024 or 2025, after learning of the federal investigation.
AHF’s Managed Care Division, Positive Healthcare Partners, operated Medicare Advantage plans for people with HIV in California, Florida and Georgia. Medicare adjusts its payments to those plans based in part on diagnoses reported by healthcare providers, with higher payments for patients expected to have higher medical costs.
Federal officials also alleged AHF submitted HIV diagnosis codes for 2017 without documentation from a face-to-face medical visit, as required by Medicare rules.
The settlement amount includes $800,000 Medicare will recoup through its risk-adjustment process. AHF must separately pay $640,000 to the federal government, plus interest.
The Justice Department said AHF received credit for cooperating with the investigation, deleting unsupported codes and strengthening its compliance program.
The case was filed in 2023 by former...
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