Complete Health Partners Holdings LLC, a management services organization running primary care practices across Florida, Alabama, and Colorado, has agreed to pay $14.1 million to the federal government to settle allegations of submitting inaccurate patient health data to inflate Medicare payments.
Medicare Advantage Program
The Medicare Advantage program allows private insurers to manage coverage for Medicare beneficiaries in exchange for fixed, government-funded monthly premiums. The federal government adjusts these payments based on a patient’s health status, reimbursing plans at significantly higher rates for individuals diagnosed with serious or chronic illnesses.
According to the lawsuit, Complete Health entered into “risk-sharing” or “sub-capitation” contracts with Medicare Advantage plans, receiving a direct financial cut of the increased payments plans collected from Medicare. Federal prosecutors alleged that Complete Health pressured its clinicians to diagnose patients with conditions they did not have, or for which medical records lacked supporting evidence.
The settlement specifically addresses allegations surrounding two conditions: major depressive disorder and drug and alcohol dependence. The lawsuit claimed these diagnoses were clinically invalid, unsupported by patient records, or entirely unrelated to the actual care delivered.
Original reporting: Tampa Free Press — read the source article.
