Humana-Owned Villages Health Settles Medicare Advantage Upcoding Case for $542M

The Villages Health, acquired by Humana in 2025, agreed to pay $542 million to settle allegations it submitted fabricated diagnosis codes to inflate Medicare Advantage risk-adjusted payments from 2020 to 2024. The Department of Justice alleged the Central Florida provider systematically manufactured diagnoses to increase capitation rates. The settlement represents one of the largest Medicare Advantage fraud recoveries to date and follows heightened federal scrutiny of MA risk adjustment practices.

Managed Care