Martin’s Point Health Care to pay $22.5M to settle false claims case

A Maine-based healthcare provider will pay nearly $22.5 million to settle allegations it violated the False Claims Act by knowingly submitting inaccurate diagnosis codes for Medicare enrollees to increase reimbursements.

Martin’s Point Health Care, which operates Medicare Advantage plans for beneficiaries living in Maine and New Hampshire, allegedly submitted risk scores for patients that did not match their medical records, the Department of Justice (DOJ) said in a press release Monday.

The settlement resolves a lawsuit brought under the qui tam provisions of the False Claims Act by Alicia Wilbur, a former manager in the risk adjustment operations group at Martin’s Point. Wilbur will receive approximately $3.8 million.