United States Announces $36.5 Million Settlement Of Medicare Fraud Lawsuit Against Matrix Medical Network
United States Attorney Office -Southern District of New York
United States Attorney for the Southern District of New York, Jay Clayton, and Special Agent in Charge of the New York Regional Office of the U.S. Department of Health and Human Services, Office of Inspector General (“HHS-OIG”), Naomi Gruchacz, announced that the United States has settled a civil healthcare fraud lawsuit against COMMUNITY CARE HEALTH NETWORK, LLC, D/B/A MATRIX MEDICAL NETWORK (“MATRIX”), a health services company headquartered in Nashville, Tennessee, that contracts with Medicare Advantage Organizations (“MAOs”) to perform in-home health assessments of Medicare patients. The settlement resolves claims that MATRIX violated the False Claim Act by causing the MAOs to submit to the Government false and invalid patient diagnoses for certain chronic conditions, thereby artificially inflating the Medicare payments the MAOs received for providing insurance coverage to patients enrolled in their plans. The Government alleges that MATRIX focused on reporting diagnoses that could lead to higher payments for its client MAOs, instead of ensuring that all of its diagnoses were appropriate and well-supported.
