A Tennessee-based in-home care company has agreed to pay $2.4 million to resolve False Claims Act allegations of submitting false diagnosis codes to inflate Medicare Advantage risk scores, the Justice Department said in an Aug. 24 news release.
Monogram Health allegedly submitted inaccurate diagnosis codes for conditions including malnutrition, substance use disorder, coagulation defects and angina pectoris between January 2021 and December 2023. Because Monogram received a percentage of the higher payments its affiliated MA plans received from CMS, it had a financial incentive to inflate beneficiaries’ risk scores.
The case was initiated through a whistleblower complaint filed by Ajay Gupta, MD, a physician formerly employed by Monogram, who will receive approximately $380,000 from the settlement. The claims are allegations only and there has been no determination of liability.
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