Nate Raymond OCTOBER 1,
2018
(Reuters) - A medical
care unit of DaVita Inc (DVA.N) has agreed to pay $270 million to resolve claims it provided
inaccurate information about patients that caused Medicare Advantage plans
operated by private insurers to obtain inflated payments from the government.
FILE PHOTO: The Department of Justice (DOJ) logo is pictured on a
wall after a news conference in New York December 5, 2013. REUTERS/Carlo
Allegri/File Photo
The civil settlement
with HealthCare Partners Holdings, which Denver-based DaVita acquired in 2012
and is in the process of selling to UnitedHealth Group Inc (UNH.N), was announced on Monday by the U.S. Justice Department.
HealthCare Partners
did not admit wrongdoing. DaVita in a statement said the $270 million will be
paid for out of escrow funds that it required HealthCare Partners’ former
owners to set aside when DaVita acquired it in 2012.
According to court
papers, HealthCare Partners, a California-based independent physician
association, contracted with insurers to provide medical services to Medicare
Advantage patients.
More than one-third of
Medicare recipients receive benefits through Medicare Advantage plans run by
private insurers, who the government pays a predetermined monthly sum for each
person they cover based on individual diagnostic traits.
Under this part of
Medicare, the healthcare program for the elderly, the government makes
so-called “risk adjustment” payments based on data it receives regarding the
health status of a patient covered by a Medicare Advantage plan.
The case stemmed from
a broader investigation into data that insurers who operate Medicare Advantage
plans submit to receive “risk adjustment” payments. The probe has already led
to the U.S. Justice Department suing UnitedHealth in a similar case.
The Justice
Departments said HealthCare Partners instituted practices that led insurers
operating Medicare Advantage plans to submit incorrect information about
patients’ diagnoses and obtain inflated payments, which the company shared in.
HealthCare Partners
also scoured patients’ records for diagnoses its medical providers failed to
record which it then submitted to the insurers for use in obtaining increased
Medicare payments, the Justice Department said.
Those allegations
stemmed from a whistleblower lawsuit filed in 2009 against various insurers
and, later, HealthCare Partners by James Swoben, a former employee of an
insurer that did business with DaVita, the Justice Department said.
His lawsuit, pending
in federal court in Los Angeles, was filed under the False Claims Act, which
allows whistleblowers to sue companies on the government’s behalf to recover
funds paid out based on fraudulent claims.
The government may
intervene in such cases. For his role in bringing the case, Swoben will receive
nearly $10.2 million, the Justice Department said.
The case is U.S. ex rel. Swoben v. Secure Horizons, et al, U.S.
District Court, Central District of California, No. 09-5013.
Reporting by Nate
Raymond in Boston; Editing by Rosalba O'Brien and Lisa Shumaker
No comments:
Post a Comment