Lawsuit Against Medical Network Settled

A tablet, a paper with the word "Lawsuit," and a pen sit on a table.

A civil health care fraud lawsuit against Community Care Health Network, doing business as Matrix Medical Network, has been settled. Matrix will pay the United States $36.5 million. The settlement resolves claims that Matrix violated the False Claim Act by causing Medicare Advantage Organizations (MAOs) to submit false and invalid patient diagnoses for certain chronic conditions, thereby artificially inflating the Medicare payments the MAOs received for providing insurance coverage to patients enrolled in their plans. The government alleges that Matrix focused on reporting diagnoses that could lead to higher payments for its client MAOs instead of ensuring that all of its diagnoses were appropriate and well supported. Read a Department of Justice press release.

SMP Resource Center products often contain links to copyrighted material. These informational links are provided for convenience and informational purposes to educate; they do not constitute a guarantee, endorsement, or approval by the SMP of the information available on any linked external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions, please email info@smpresource.org.