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Florida Healthcare Company to Pay $14.1 Million in Medicare Fraud Settlement
Jacksonville-based Complete Health has agreed to a $14.1 million settlement following allegations of inflating patient diagnoses to overbill Medicare, the U.S. Department of Justice announced Monday.
According to DOJ officials, from 2020 through 2023, Complete Health routinely submitted false diagnosis codes for patients, including claims of drug and alcohol dependency and bipolar disorder, none of which were clinically supported. These inaccurate diagnoses allowed the company to receive higher payments under Medicare Advantage (Medicare Part C).
Unlike traditional Medicare Parts A and B, which reimburse providers on a fee-for-service basis, Medicare Advantage pays private health plans a fixed monthly rate based on the severity of a patient’s health conditions. By inflating diagnoses, Complete Health sought to increase these monthly premiums improperly.
“Companies that inflate medical conditions to boost profits at the expense of Medicare Advantage enrollees will be held accountable,” said Isaac Bledsoe, Special Agent in Charge of the Department of Health and Human Services Office of Inspector General. He emphasized that the settlement underscores the commitment to protecting federal healthcare programs from fraudulent activities.
Complete Health, which operates in Florida, Alabama, and Colorado, provides management services to healthcare providers. U.S. Attorney Gregory Kehoe of the Middle District of Florida noted that the settlement sends a clear message to the community and local medical providers that enforcement efforts in this area remain strong.
This case highlights ongoing federal efforts to ensure the integrity of Medicare Advantage, a program designed to deliver necessary care rather than serve as a source of improper financial gain.