California Health Care Provider To Pay $270 Million To Settle Medicare Fraud Claims

A California health care provider agreed to pay the Federal government $270 million to settle allegations that it fraudulently inflated claims to Medicare.

HealthCare Partners Holdings LLC, d/b/a DaVita Medical Holdings LLC faced charges by the Department of Justice for allegedly providing false information to Medicare via incorrect diagnosis codes through Medicare Advantage Organizations with which it contracted. The MAOs allegedly sent the incorrect diagnosis codes to the Medical Services Organizations operated by DaVita, who, in turn, allowed DaVita to allegedly retain a portion of the monies paid out to the MAOs by Medicare.

In addition, DaVita was also alleged to be operating “one way” chart reviews of partner MAOs for diagnoses the MAOs did not report. DaVita then allegedly submitted the diagnoses to Medicare for payment – however, DaVita allegedly did not report inaccurate diagnosis codes that may have reduced payments to it by Medicare or required repayment of incorrectly-paid monies back to the Federal program.

Per the Federal government, the “one way” chart review allegations were the product of a whistleblower acting under the qui tam provisions of the Federal False Claims Act (a/k/a, “Lincoln’s Law”). The provision allows whistleblowers to initiate an action against the party alleged to be engaged in fraud, which the Federal government may take on and prosecute as its own should investigators judge that the allegations have sufficient merit.

Federal prosecutors say that the self disclosures and overall cooperation by DaVita over the course of the investigation prompted it to agree to a less severe punishment than it may have incurred otherwise.

The Law Offices of Bjorn Brunvand have been representing people charged with capital murder, felony drug charges, drunk driving, government fraud, and white-collar crimes for over a quarter century. Contact our office today to discuss your Tampa Bay-area state or federal charges.


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