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Massive Medicare Fraud Case Made Possible by Whistleblower Settled to Tune of $270 Million

Healthcare Partners Holdings LLC, a subsidiary of the largest dialysis providers in the nation (DaVita Inc.), agreed to pay $270 million to settle a whistleblower lawsuit. The organization was alleged to have defrauded the government through Medicare Advantage insurance plans for several years.

Medicare Advantage plans cover more than one-third of all seniors in the United States, but its billing practices have routinely been made the subject of scrutiny by government investigators. There have been multiple high-profile whistleblower claims in the last year accusing insurers of overstating how sick patients were to boost payments.

Claims made in the case

HealthCare Partners was accused of engaging in improper medical coding from early 2007 to late 2014. The company submitted “unsupported” diagnostic codes which allowed for higher payments than would have been due had the proper diagnostic codes been submitted.

One example of such a submission was for spinal enthesopathy, which was improperly diagnosed in patients in several states between November 2011 and December 2014. This diagnosis enabled larger payouts.

The company also partnered with a Nevada firm from 2010 to early 2016, sending health care providers out to patients in their homes. This is a practice commonly used to get larger Medicare payouts. The house calls routinely resulted in either undocumented or otherwise unsupported diagnostic codes.

The company admits no fault as part of the settlement. However, the case is just one more example of the necessity of whistleblowers in uncovering healthcare fraud. Government officials say healthcare fraud is the most costly form of fraud to the government each year, and it is almost impossible to root out without inside information from a whistleblower.

If you are aware of fraud occurring within a healthcare organization, reach out to an experienced whistleblower attorney at Kardell Law Group as soon as possible.

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