diagnoses

Aug. 3 (UPI) — Florida-based Complete Health will pay a $14.1 million settlement stemming from allegations that it inflated patient diagnoses to overcharge Medicare, the Justice Department said Monday.

DOJ officials said from 2020 to 2023, the company routinely added bogus diagnosis coding to its billing — saying its patients had drug and alcohol dependencies as well as bipolar disorder — that “were not clinically valid.”

Under Medicare Part C, also known as Medicare Advantage, the government pays a fixed monthly rate to private health providers depending on the severity of a patient’s diagnosis.

This differs from Medicare parts A and B, in which a provider is paid fees per service.

DOJ said the Complete Health added the false diagnoses to receive a higher monthly premium per patient.

“Companies that attempt to improperly boost their own profits by reporting bogus medical conditions of Medicare Advantage enrollees — as alleged in this case — will be held responsible for their actions,” said Special Agent in Charge Isaac Bledsoe, of the Department of Health and Human Services Office of Inspector General, in a statement.

“Today’s settlement demonstrates our office’s commitment to safeguarding the integrity of federal health care programs, including Medicare Advantage, which exist to provide necessary care to enrollees, not as a vehicle for improper financial gain,” Bledsoe added.

Complete Health is a management services organization based in Jacksonville that operates in Florida, Alabama and Colorado.

“This settlement sends a strong message to our district, its residents, and medical providers doing business here, that our focus on this vital practice area has not wavered,” said U.S. Attorney Gregory Kehoe, of the Middle District of Florida, in a statement.

Carly Simon on Monday shared a lengthy and candid letter regarding the state of her health, which she said led to her recent withdrawal from the public eye.

The 83-year-old “You’re so Vain” singer and two-time Grammy winner in a statement shared with The Times revealed she has been diagnosed with Parkinson’s disease and has dedicated time away from the spotlight to understand and learn how to live with the illness. Simon said she decided to come forward about her health issues after “so many people have written to me, kindly wondering about my relative silence.” She did not specify when she was diagnosed.

Parkinson’s disease, according to the Mayo Clinic, is a nervous system movement disorder that worsens with time and cannot be cured. Tremors are a common symptom of Parkinson’s disease, which also notably afflicts “Back to the Future” star Michael J. Fox.

Simon explained in her statement that she experienced arthritis in both of her knees and one hip prior to receiving her diagnosis. She had those three joints replaced — “out with the old and in with delicate bouquets of metal and plastic” — but experienced worsening mobility after, including difficulty walking and standing from couches and low chairs.

“Eventually, there were periods when I could not walk without considerable help,” she continued. “My family and I knew that something more was going on.”

She said she was diagnosed with Parkinson’s after a trip to the Mayo Clinic and underwent treatment and started taking medication to aid with her symptoms.

“There is no tidy predictable schedule to the illness,” she said.

Simon also wrote that her experience with Parkinson’s wrought “anxiety, depression, exhaustion, an apathy.” Of the last, Simon recalled lying like a starfish “while nothing inside is telling you to get up, read, watch, sing, call someone, or do much of anything at all.”

Simon revealed that in the same period, she underwent surgery to treat skin cancer, specifically basal cell carcinoma on her face. The singer’s two sisters died of different cancers days apart in 2022. She said she felt self-conscious about her appearance post-surgery and retreated further from the public. “This gave my inner critic quite a lot of new material,” she wrote.

The singer, who likened herself to an “all-season” hibernating bear, said “I have not stopped living, and I have not stopped working” amid her health issues. She then promoted her upcoming album “Comes in Waves,” her first album of original music since 2008. “Comes in Waves” arrives Aug. 14. She is set to release the song “Peaches” from the album on Friday.

“Music has always known when to arrive,” she wrote. “It has rescued me more times that I can count.”

“Working on the music gave shape to days that did not always have much shape,” she said. “It gave me somewhere to go without having to leave the room. It reminded me that illness can change your life without becoming the whole of your life.”

For Simon, her Parkinson’s battle has proved “difficult, frustrating, and sometimes frightening,” but not a complete obstacle to her life. She expressed gratitude to her friends, family, caregivers and medical teams for their support.

“These days I move more slowly, I lean on others more than I once did, and I have learned to accept that every day will look a little different,” she concluded. “But I am still very much here.”