Company Resolves Medicare Advantage Case


Martin’s Point Health Care Inc. has agreed to pay almost $22.5 million to resolve allegations that it violated the False Claims Act by submitting inaccurate diagnosis codes for its Medicare Advantage (MA) plan enrollees in order to increase reimbursements from Medicare. The United States alleged that, from 2016 to 2019, Martin’s Point engaged in chart reviews of their MA beneficiaries to identify additional diagnosis codes that had not been submitted to Medicare. 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. Watch a story from WGME and read a Department of Justice press release.

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