Martin's Point Health Care to pay $22.4 million over allegations of false Medicare Advantage claims
Portland-based Martin's Point Health Care has agreed to pay more than $22 million to settle civil fraud allegations involving its Medicare Advantage claims.
According to the U.S. Department of Justice, from 2016 to 2019, Martin's Point added diagnosis codes to the charts of Medicare Advantage enrollees that resulted in higher reimbursements but were not supported by patients' medical records.
Under the terms of the settlement, a whistleblower who was a former manager in Martin's Point Risk Adjustment Operations, Alicia Wilbur, will receive roughly $3.8 million.
In a written statement, Martin's Point says the settlement is not an admission of liability. However, the organization says new leadership at Martin's Point has established a team that's tasked specifically with oversight of risk adjustment practices.