Siddhartha Pagidipati, the former Chief Operating Officer (COO) of Freedom Health, has agreed to pay USD 750,000 to resolve his alleged role in the scheme, the Justice Department announced.
Freedom Health and its related corporate entities also agreed to pay USD 32.5 million to resolve allegations that they violated the 'False Claims Act' by engaging in illegal schemes to maximize their payment from the government in connection with their Medicare Advantage plans.
The government alleged that Freedom Health submitted or caused others to submit unsupported diagnosis codes to a federal health agency which resulted in inflated reimbursements from 2008 to 2013 in connection with two of their Medicare Advantage plans operating in Florida.
It also alleged that Freedom Health made material misrepresentations to the agency regarding the scope and content of its network of providers (physicians, specialists and hospitals) in its application. The government's settlement with Mr Pagidipati resolves his alleged role in this latter scheme.
"Today's result sends a clear message to the managed care industry that the United States will hold managed care plan providers responsible when they fail to provide truthful information."
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