Simplified for easy reading: Freedom Health and
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Posted On: 06/03/2019 9:26:00 PM
Simplified for easy reading:
Freedom Health and Optimum Healthcare are based in Tampa, Florida and run by Dr. Kiranbhai "Kiran" C. Patel, and Siddhartha "Sidd" Pagidipati.
The original whistleblower complaint accused Freedom and Optimum of perpetrating a billing fraud known as risk gaming.
Risk gaming occurs when payers inflate patient risk scores and subsequently request higher payments from the government. A patient’s risk score is determined by their diagnosis and treatment requirements, which in the case of gaming is either inflated, unsubstantiated or false.
The suit alleges that up to 80 percent of the payment codes submitted by the payers were unsubstantiated, in addition to unnecessary office visits for members designed to look for ways to inflate risk scores.
Additionally, the lawsuit alleges that the insurers, aided by Mr. Pagidipati, fraudulently convinced CMS to allow expansion of their healthcare services into counties in Florida and the Carolinas.
Despite claiming to CMS that they had a sufficient network of doctors, clinics, and hospitals to expand into the coverage area, there was no provider network in place.
https://healthpayerintelligence.com/news/two-...fraud-suit
Freedom Health and Optimum Healthcare are based in Tampa, Florida and run by Dr. Kiranbhai "Kiran" C. Patel, and Siddhartha "Sidd" Pagidipati.
The original whistleblower complaint accused Freedom and Optimum of perpetrating a billing fraud known as risk gaming.
Risk gaming occurs when payers inflate patient risk scores and subsequently request higher payments from the government. A patient’s risk score is determined by their diagnosis and treatment requirements, which in the case of gaming is either inflated, unsubstantiated or false.
The suit alleges that up to 80 percent of the payment codes submitted by the payers were unsubstantiated, in addition to unnecessary office visits for members designed to look for ways to inflate risk scores.
Additionally, the lawsuit alleges that the insurers, aided by Mr. Pagidipati, fraudulently convinced CMS to allow expansion of their healthcare services into counties in Florida and the Carolinas.
Despite claiming to CMS that they had a sufficient network of doctors, clinics, and hospitals to expand into the coverage area, there was no provider network in place.
https://healthpayerintelligence.com/news/two-...fraud-suit
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