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DaVita Subsidiary Settles Risk Adjustment Billing Case for $270 Million

Posted by David Fong on Nov 15, 2018 8:00:00 AM

Modern Healthcare reported recently that DaVita Medical Holdings will pay a $270 million settlement to the federal 270MM settlementgovernment over allegations that the company incorrectly inflated certain Medicare Advantage reimbursements above the fixed, risk-adjusted rate owed for care.


The settlement stems from improper medical coding guidance from DaVita's subsidiary group HealthCare Partners that drew CMS payments higher than what was owed. DaVita voluntarily disclosed these billing practices and cooperated with the federal investigation, the Justice Department said, leading to "favorable resolution of potential claims arising from the conduct."


According to the Justice Department, HealthCare Partners disseminated the incorrect billing codes that led to the inflated payments that DaVita then shared with HealthCare Partners. According to the complaint, HealthCare Partners searched patient medical records for diagnoses that providers may not have listed and submitted them to the Medicare Advantage organizations for Medicare payments. HealthCare Partners excluded inaccurate diagnosis codes that would have lowered reimbursements.


Aviacode offers HCC coding and data validation review for risk adjustment providers.  In addition, Aviacode can help you find coding compliance problems before they become an issue. Our comprehensive accuracy review of coding-related practices is aimed at maximizing your revenue efficiency, identifying potential coding compliance risks, and stopping coding-related denials.


Aviacode offers a comprehensive review of your current coding process, which will identify errors and help prevent future coding-related denials. Our experienced and credentialed auditors are up to date with the latest coding guidelines and changes to ensure that audits are accurate, consistent, and compliant. Audits are completed and reports returned typically within three weeks. In addition, we can provide provider and staff education tailored to meet your needs as desired.

Topics: Medical Coding, HCC Coding, Coding Compliance, Medical Coding Audits, Risk Adjustment