AIDS Healthcare Foundation has agreed to pay $1.44 million to settle allegations of submitting false or invalid diagnosis codes to increase Medicare Advantage payments.
Why it matters. The settlement highlights the government's efforts to maintain the integrity of Medicare Advantage programs and holds healthcare organizations accountable for accurate billing.
AIDS Healthcare Foundation, a non-profit organization based in Los Angeles, California, has agreed to pay $1.44 million to resolve allegations that it violated the False Claims Act by submitting or failing to delete false or invalid diagnosis codes in order to increase payments that it received from the Medicare Advantage program.
AIDS Healthcare Foundation Agrees To Pay $1.44M To Settle False Claims Act Allegations
The settlement announced today resolves allegations that, for payment years 2017 to 2023, AHF failed to timely investigate and delete diagnosis codes that were either inaccurate or not documented in medical records.
Medicare Advantage organizations have a responsibility to ensure the accuracy of diagnosis codes they submit for payment. When entities fail to correct information they know is wrong, they undermine the integrity of a program millions of seniors rely on,” said Acting Deputy Inspector General for Investigations Miranda L. Bennett of the U.S. Department of Health and Human Services Office of Inspec…
AHF received credit under the Department of Justice’s guidelines for taking disclosure, cooperation, and remediation into account in False Claims Act resolutions, Justice Manual § 4-4.112.
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AIDS Healthcare Foundation Agrees To Pay $1.44M To Settle False Claims Act Allegations
The United States further alleges that, for payment year 2017, AHF knowingly submitted diagnosis codes for HIV (ICD-10 B20) where the diagnosis was not documented in any medical record for a face-to-face visit, in violation of CMS requirements that all diagnosis code submissions must be documented as a result of a face-to-face visit.
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Ms. Irons will receive $259,200 as her share of the federal recovery.
Medicare Advantage organizations have a responsibility to ensure the accuracy of diagnosis codes they submit for payment. When entities fail to correct information they know is wrong, they undermine the integrity of a program millions of seniors rely on,
The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section and the U.S. Attorney’s Office for the Central District of California, with assistance from the Department of Health and Human Services, Office of Inspector General.
CMS uses a health-based risk adjustment model — the Hierarchical Conditions Category (HCC) model — that takes into account diagnoses reported by healthcare providers.
AIDS Healthcare Foundation (AHF) provides care and services to HIV patients in the United States and other countries.
