A former executive of a South Florida Medicare Advantage health plan has been charged in an alleged scheme that led to the federal government making $53 million in overpayments to the plan, the U.S. Department of Justice announced Thursday.
Kenia Valle Boza, 39, former director of Medicare risk adjustment analytics at Miami-based HealthSun Health Plans Inc. was charged with one count of conspiracy to commit health care fraud and wire fraud, two counts of wire fraud and three counts of major fraud against the United States.
The allegations include entering false information about patients having chronic conditions into medical records to increase amounts of money that the federal Centers for Medicare & Medicaid Services, or CMS, paid to the health plan.
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“As a result of the scheme, Valle and her co-conspirators allegedly caused HealthSun to submit to CMS tens of thousands of false and fraudulent diagnosis codes, which resulted in CMS overpaying HealthSun millions of dollars,” a Justice Department news release said.
The health plan was not charged, in part because it agreed to repay $53 million.
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