Medicare Advantage Provider and Physician to Pay $5 Million to Settle False Claims Act Allegations8/8/2019
California-based healthcare provider, Beaver Medical Group L.P., and one of its physicians, Dr. Sherif Khalil, have agreed to pay a total of $5,039,180 to resolve allegations that they reported invalid diagnoses to Medicare Advantage plans and thereby caused those plans to receive inflated payments from Medicare, the Justice Department announced. The Medicare Advantage Organizations (MAOs) often compensated Beaver with a share of the payments that the MAOs received from Medicare for the beneficiaries under Beaver’s care. Thus, Beaver had a financial incentive to submit additional diagnosis codes to the MAOs in order to increase the payments that the MAOs received from Medicare. The settlement resolves allegations that Beaver and Dr. Khalil knowingly submitted diagnoses that were not supported by the beneficiaries’ medical records in order to inflate the payments that the MAO received from Medicare. The experts of GEC have a wide expanse of knowledge and expertise in the healthcare industry which can range from patients, healthcare providers, payers, and even antitrust issues stemming from hospital and provider integration, third-party payment and pricing, medical staffing and compensation practices, and Affordable Care Act compliance. Add us to your expert file and get our next news post automatically. We'll never share your contact information with others. Comments are closed.
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