Martin's Point agreed Monday to pay $22,485,000 in order to resolve allegations that it violated the False Claims Act between 2016 and 2019.
WASHINGTON — Martin's Point Health Care Inc. agreed Monday to pay $22,485,000 in order to resolve allegations that it violated the False Claims Act between 2016 and 2019.
The U.S. Department of Justice said in a news release Monday that the organization allegedly violated the act by "submitting inaccurate diagnosis codes for its Medicare Advantage Plan enrollees in order to increase reimbursements from Medicare."
Martin's Point operates Medicare Advantage Plans, or MA Plans, for beneficiaries who are living in Maine and New Hampshire, the DOJ said.
"The United States alleged that, from 2016 to 2019, Martin’s Point engaged in chart reviews of their Medicare Advantage beneficiaries to identify additional diagnosis codes that had not been submitted to Medicare," the release stated. "Many of the additional codes submitted, however, were not properly supported by the patients’ medical records. The government alleged that Martin’s Point nevertheless submitted those diagnosis codes, which resulted in higher payments from [the Centers for Medicare and Medicaid Services."
The civil settlement reportedly includes the resolution of claims brought under the whistleblower provisions of the False Claims Act by Alicia Wilbur, who is a former manager in Martin's Point's Risk Adjustment Operations group, according to the release. The whistleblower...
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