Martin’s Point Health Care to Pay $22.5 Million in Medicare Fraud Settlement

Martin’s Point Health Care Inc. has agreed to pay nearly $22.5 million to settle allegations of submitting inaccurate codes for Medicare Advantage Plan enrollees, according to federal prosecutors. This settlement represents the largest Medicare fraud case in the history of the state of Maine.

The company was accused of submitting false diagnosis codes for Medicare Advantage Plan enrollees in Maine and New Hampshire between 2016 and 2019. By submitting these inaccurate codes, Martin’s Point Health Care aimed to increase Medicare reimbursements.

The U.S. attorney’s office in Maine confirmed the settlement but did not provide further details. A spokesperson for Martin’s Point Health Care was unavailable for immediate comment.

The allegations against Martin’s Point Health Care were brought to light by a whistleblower, who is entitled to receive approximately $3.8 million as part of the settlement.

According to the Justice Department, Martin’s Point Health Care attempted to identify additional codes for reimbursement even though these codes were not supported by patients’ medical records. This deceptive practice allowed the company to inflate their claims for reimbursement.

By resolving this case, federal prosecutors hope to send a clear message to the Medicare Advantage community that the United States will take decisive action against those who knowingly submit false claims for reimbursement.

These allegations highlight the importance of accurate coding practices and the need for healthcare providers to ensure that their claims for reimbursement are supported by solid medical evidence.

Source: Martin’s Point Health Care to Pay $22.5 Million in Medicare Fraud Settlement / Express Healthcare Management

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