The Villages Health System LLC (TVH), a Florida-based healthcare provider, has agreed to a $541.5 million settlement to resolve allegations of submitting false diagnosis codes to Medicare Advantage programs between 2020 and 2024. The False Claims Act violations involved inflating payments by using unsupported or undocumented diagnosis codes, which increased capitated payments to Medicare Advantage Organizations (MAOs). The settlement acknowledges TVH’s cooperation, including self-disclosure via the HHS-OIG Self Disclosure Protocol and remedial actions. TVH also filed for Chapter 11 bankruptcy in 2025, with the court approving the settlement. MAOs involved, including Humana Inc. and UnitedHealthcare, are returning overpayments. The Justice Department’s Civil Division, U.S. Attorney’s Office, and HHS-OIG collaborated on the resolution. The claims are allegations only, with no liability determination made.
Source: U.S. Department of Justice (DOJ).
Materials reproduced from https://www.justice.gov/.
No endorsement by the DOJ is implied.
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