Health care provider to pay largest Medicare fraud settlement in Maine history

PORTLAND, Maine (AP) — Martin’s Point Health Care Inc. will pay nearly $22.5 million to resolve allegations of submitting inaccurate codes for Medicare Advantage Plan enrollees to increase Medicare reimbursements, federal prosecutors said Monday.

The U.S. attorney’s office in Maine confirmed it was the largest Medicare fraud settlement in state history. A Martin’s Point representative didn’t immediately return a phone call seeking comment on Monday. The company was accused of submitting the inaccurate diagnosis codes for Medicare Advantage Plan enrollees in Maine and New Hampshire between 2016 and 2019.

“Today’s result sends a clear message to the Medicare Advantage community that the United States will take appropriate action against those who knowingly submit inflated claims for reimbursement,” said Michael D. Granston, deputy assistant attorney general of the Justice Department’s civil division’s commercial litigation branch.

The allegations against the Portland-based healthcare provider stemmed from a complaint brought by a whistleblower who’s entitled to a claim of the settlement, approximately $3.8 million, officials said.

The Justice Department said Martin’s Point sought to identify additional codes that could be submitted for reimbursement even though many codes weren’t supported by patients’ medical records.

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