Monogram Health Settles Medicare Advantage Upcoding Claims for $2.4 Million
Monogram Health, a home health company, will pay $2.4 million to settle Justice Department allegations that it overcharged Medicare Advantage plans through inflated diagnostic codes in contracts with Cigna and Humana. The settlement resolves claims that Monogram systematically upcoded patient diagnoses to increase risk-adjusted payments to MA plans. The enforcement action reflects continued federal scrutiny of diagnosis coding practices in Medicare Advantage, particularly involving delegated provider arrangements that impact plan payments.
This settlement underscores federal enforcement focus on risk adjustment accuracy in delegated arrangements, a compliance model with parallels in Medicaid managed care where plans similarly contract with third-party providers for care delivery and coding.
Managed Care
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