Complete Health Partners pays $14.1M in Medicare Advantage upcoding settlement

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Complete Health Partners pays $14.1M in Medicare Advantage upcoding settlement

Plus: NY ophthalmology practices pay $2.3M in TCD kickback sweep. The day's rules, money, and enforcement, sourced and tiered below.

Record

A Jacksonville company that manages doctors' offices is paying $14.1 million after prosecutors say it told coders to add fake mental-health and addiction diagnoses just to collect bigger Medicare Advantage checks.

The alleged scheme ran 2020-2023, adding unsupported codes for substance dependence and depressive, bipolar or paranoid disorders. The whistleblower, a former insurer risk-adjustment official, collects $2.47M.

Record

Two New York eye doctors' practices are paying $2.3 million over a scheme billing Medicare and Medicaid for unneeded brain-blood-flow ultrasounds, the same kickback scheme that started with five Florida eye practices in January.

The kickback arrangement ran through a third-party testing company. Both NY practices signed cooperation deals with federal prosecutors, meaning more defendants in the multistate sweep are likely.

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