Federal officials said the company had a financial incentive to report additional diagnoses because higher patient risk scores can result in higher Medicare payments to the health plans it contracts with.

What This Story Is About

• Monogram Health, a Tennessee-based Medicare Advantage provider, agreed to pay $2.4 million to resolve federal allegations that it submitted inaccurate diagnosis codes to increase Medicare payments.

Why It Matters

• Federal officials said the alleged coding practices increased patients’ risk scores, leading to higher payments from the Medicare Advantage program.

What Happens Next

• The settlement resolves civil False Claims Act allegations involving conduct from 2021 through 2023, according to the Department of Justice.
• A former Monogram physician who filed the whistleblower lawsuit will receive about $380,000 from the recovery.

Catch Up

• 4 patients experienced ‘adverse’ reactions after medication mix-up, Nashville hospital confirms

NASHVILLE, Tenn. (WSMV) - Tennessee-based Monogram Health has agreed to pay $2.4 million to settle federal allegations that it caused false Medicare Advantage claims to be submitted.

The U.S. Department of Justice alleged that Monogram submitted diagnosis codes that were not clinically accurate, were not supported by patient records or did not affect a patient’s treatment or care.

Monogram provides in-home care and related services to Medicare Advantage beneficiaries. Federal officials said the company had a financial...

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