A Florida-based healthcare provider group has agreed to pay $541.5 million to resolve False Claims Act allegations of submitting false diagnosis codes to inflate Medicare Advantage payments, one of the largest MA risk adjustment settlements on record, the Justice Department said in an Aug. 27 news release.
The Villages Health System self-disclosed the conduct to HHS-OIG in December 2024, admitting it had submitted invalid diagnosis codes to three Medicare Advantage organizations — Humana, UnitedHealthcare and Florida Blue — between 2020 and 2024. The codes lacked adequate support in patient medical records or were based on amendments not initiated or approved by the rendering provider.
The Justice Department credited TVH for its voluntary self-disclosure and cooperation in connection with the settlement. The bankruptcy court approved the settlement Aug. 25, as TVH filed for Chapter 11 bankruptcy in July 2025.
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