The United States has announced a $36.5 million settlement with Matrix Medical Network over allegations involving Medicare Advantage payments. Federal authorities alleged that the company reported unsupported medical diagnoses that led to higher payments from Medicare. The settlement resolves claims under the False Claims Act and requires Matrix Medical Network to comply with a five-year Corporate Integrity Agreement.
The United States has reached a $36.5 million settlement with Matrix Medical Network, a healthcare services company headquartered in Nashville, Tennessee. The company performs in-home health assessments for patients enrolled in Medicare Advantage plans.
According to the government, Matrix Medical Network caused Medicare Advantage Organizations (MAOs) to submit false or invalid diagnosis information to the federal government. These diagnoses were allegedly used to increase risk scores for patients, which resulted in higher Medicare payments to insurance plans.
The allegations focus on activities that took place between 2014 and 2019. During that period, Matrix Medical Network conducted in-home assessments and reported diagnosis codes that were later submitted to the Centers for Medicare and Medicaid Services (CMS).
Federal authorities claimed that some of these diagnoses were not adequately supported by clinical information and did not meet required coding standards.
Among the medical conditions cited...
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