News: DaVita group settles MA false claims probe with DOJ for $270 million

DaVita Medical Holdings, a subsidiary of the dialysis company DaVita Inc., will pay $270 million to settle allegations that they incorrectly inflated certain Medicare Advantage (MA) reimbursements above the fixed, risk-adjusted rate owed for care, Modern Healthcare reported.

According to the Department of Justice (DOJ) statement, DaVita agreed to the settlement without admitting any wrongdoing, FierceHealthcare reported.

The settlement stems from improper medical coding guidance from DaVita’s subsidiary group HealthCare Partners (now doing business as DaVita Medical Holdings) that drew CMS payments higher than what was owed, according to Modern Healthcare. DaVita voluntarily disclosed those billing practices and cooperated with the investigation, according to the DOJ.

The allegations say that DaVita and HealthCare Partners contracted with private MA organizations to bill CMS, and HealthCare Partners told the organizations how it wanted them to bill CMS for certain services. The issue, according to the DOJ, was that HealthCare Partners disseminated incorrect billing codes that led to inflated payments that DaVita then shared with HealthCare Partners. 

The settlement also included resolution of a second whistle-blower allegation that HealthCare Partners searched patient medical records for diagnoses that providers may not have listed and submitted them to the MA organizations for payment. HealthCare Partners excluded inaccurate diagnosis codes that would have lowered reimbursements, Modern Healthcare reported.

The whistle-blower stands to receive more than $10 million from the settlement.

Editor’s note: To read Modern Healthcare’s coverage of this story, click here. To read FierceHealthcare’s coverage of this story, click here. To read the DOJ statement on the settlement, click here. To read about other recent fraud cases, click here.