The Martin’s Point Health Care facility at Brunswick Landing in 2021. The company has six health care centers in southern Maine and New Hampshire. C. Thacher Carter / The Times Record
Martin’s Point Health Care in Portland has agreed to pay more than $22 million to the U.S. government for alleged Medicare fraud.
The agreement also says the company will pay $3.8 million to Alicia Wilbur, a former manager at Martin’s Point from mid-2016 through late 2017 who filed a whistleblower complaint against the company in June 2018 alleging it had violated the False Claims Act. Wilbur’s complaint was unsealed in federal court Monday.
The complaint alleged that Martin’s Point abused the federal Medicare Advantage program, which allows beneficiaries to enroll in managed care insurance plans for per-person reimbursements. These plans are based on demographic information and diagnoses and are adjusted according to changes in this information.
Medicare Advantage is supplemental insurance for patients who have Medicare coverage – typically those 65 and older – that covers costs Medicare doesn’t pay for, such as vision, hearing and dental, drug costs not covered by Medicare, and other health services not covered.
From 2016 to 2019, Martin’s Point assigned additional diagnoses to patients in order to get higher reimbursements using information that was not supported by medical records, according to Wilbur’s allegations in court documents.
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