A settlement has been reached to resolve False Claims Act allegations against DaVita Medical Holdings LLC.
The allegations arose from a lawsuit that claimed HealthCare Partners Holdings LLC, doing business as DaVita Medical Holdings LLC provided inaccurate information that caused Medicare Advantage Plans to receive inflated Medicare payments.
“Federal healthcare programs rely on the accuracy of information submitted by healthcare providers to ensure that managed care plans receive the appropriate compensation,” said Assistant Attorney General Joseph H. Hunt of the Department of Justice’s Civil Division. “We will pursue those who undermine the integrity of the Medicare program and the data it relies upon. This also illustrates that the Department encourages and incentivizes health care organizations to make voluntary disclosures to the government when they identify false claims.”
Under Medicare Advantage, Medicare beneficiaries have the option of enrolling in and obtaining health care from Medicare Advantage Plans that are owned and operated by private Medicare Advantage Organizations (MAOs).
According to a whistleblower, HealthCare Partners engaged in “one-way” chart reviews in which it scoured its patients’ medical records for diagnoses its providers may have failed to record. It then submitted these “missed” diagnoses to MAOs to be used by them in obtaining increased Medicare payments. At the same time, it ignored inaccurate diagnosis codes that should have been deleted and that would have decreased Medicare reimbursement or required the MAOs to repay money to Medicare.
The whistleblower, James Swoben, who was a former employee of a MAO that did business with DaVita, will receive $10,199,100 for the settlement of the “one way” allegations.
