Oct 26 (Reuters) – A former executive of Florida health insurance company HealthSun Health Plans Inc, which offers privately managed but publicly funded Medicare Advantage plans, has been charged with orchestrating a scheme that resulted in the federal government being overbilled by $53 million, prosecutors announced Thursday.
According to an indictment filed in Miami federal court, Kenia Valle Boza, who served as Director of Medicare Risk Adjustment Analytics at HealthSun from 2017 to 2020, fraudulently told the federal government that beneficiaries of HealthSun Medicare Advantage plans had chronic conditions that they did not really have.
That allegedly allowed the company to receive larger reimbursements from the U.S. Centers for Medicare and Medicaid Services (CMS).
Prosecutors said they did not charge HealthSun itself, thanks to its cooperation in the case and agreement to return $53 million in overpayments to CMS.
Source: Former HealthSun exec accused of Medicare fraud resulting in $53 mln overpayment / Reuters