The Villages Health reaches $541M False Claims Act settlement with DOJ
The Villages Health System has agreed to a $541.5 million settlement to resolve allegations that it submitted false diagnosis codes to secure higher payouts in Medicare Advantage.
The Villages Health System has reached a $541.5 million settlement with the Department of Justice to resolve allegations of submitting false diagnosis codes to Medicare Advantage organizations. This matter came to light when TVH reported in December 2024 through the Department of Health and Human Services Office of Inspector General's self-disclosure protocol.
The Medicare Advantage program pays fixed monthly amounts to providers for their beneficiaries, with adjustments for sicker patients who generate higher healthcare costs. By falsely inflating diagnoses, some plans could receive higher reimbursements from the Centers for Medicare & Medicaid Services. Assistant Attorney General Brett A. Shumate emphasized that the settlement holds accountable entities that manipulate payments through invalid diagnoses, while also crediting organizations that disclose wrongdoing and cooperate with investigations.
The false claims involved three MAOs—Humana, UnitedHealthcare, and GuideWell—and those plans have agreed to return funds associated with the fraudulent diagnoses. TVH, which provides medical care to individuals in Florida's Villages complex, was acquired by Humana's CenterWell unit in a 2025 bankruptcy deal. The settlement was approved by bankruptcy courts on August 25.
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