DOJ Declines to Intervene in Risk Adjustment Qui Tam Suit Brought Against Numerous Medicare Advantage Plans


The District Court for the Central District of California has unsealed a qui tam complaint filed in May 2018 against Mobile Medical Examination (“MedXM”) and a number of Medicare Advantage Organizations, including United Healthcare, Wellpoint, Aetna, Health Net, and Molina Healthcare. The suit by former employees of MedXM alleged that the defendants engaged in a scheme to submit false claims for payment to the federal healthcare programs by inflating risk adjustment payments and providing kickbacks to Medicare Advantage enrollees. Specifically, the MAOs contracted with MedXM to perform free in-home health assessments even though in-home services were specifically not covered under these plans. The Department of Justice declined to intervene in the suit.

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