A medical group, its subsidiary and its former physician president will pay more than $60 million for allegedly submitting false diagnosis codes to inflate Medicare Advantage payments, according to a March 26 news release from the Justice Department.
What happened?
- Los Angeles-based Seoul Medical Group and its subsidiary will pay $58.7M, and former president Min Young Cha, MD, who was president and majority owner until 2023, will pay $1.76M for his role in the scheme.
- From 2015 to 2021, Seoul Medical — which has worked with around 150 primary care providers and 1,000 specialists — falsely claimed patients had spinal enthesopathy and sacroiliitis, conditions that increase Medicare risk scores and payments.
- These actions led to inflated payments from Medicare to the Medicare Advantage plans, which then passed funds to Seoul Medical.
Who else is involved?
- Renaissance Imaging Medical Associates, a Los Angeles-based radiology group, will also pay $2.35M for allegedly helping fabricate radiology reports to support the false diagnoses.
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