Freedom health inc8/2/2023 ![]() Sewell became familiar with the defendants' various schemes to bilk money from Medicare and Medicaid. Sewell, worked at Freedom and Optimum from 2007 to 2012 and rose through the ranks to become chief medical officer before transferring to the Medicare Revenue Management Department and assuming the role of vice president of special projects. Siddhartha "Sidd" Pagidipati, Freedom's former chief operating officer, will pay the United States $750,000 to resolve allegations regarding his role in the allegedly fraudulent expansion of Freedom's and Optimum's service areas. Under the settlement agreements, announced by the government today, Freedom Health and Optimum Healthcare will pay the government $16.7 million to resolve the allegations of risk adjustment fraud and $15 million for the allegedly fraudulent expansion of their service areas, for a total settlement amount of $31.7 million. The whistleblower settlement over risk adjustment fraud is the nation's largest. ![]() Pagidipati, fraudulently induced the Centers for Medicare & Medicaid Services (CMS), which administers the programs, to allow them to expand their health insurance offerings into new counties in Florida and the Carolinas by falsely representing that they had a sufficient network of doctors, clinics, and hospitals available to serve their enrollees in the expanded service area when they had no such networks in place. The complaint also alleges that Freedom and Optimum, with the help of Mr. Freedom and Optimum fraudulently inflated their members' risk scores and the corresponding risk adjustment payments they received from CMS, the complaint alleges, by claiming their members were treated for conditions they either did not have or were not treated for. ![]() Higher risk scores are supposed to reflect treatment of sicker patients, and risk-adjustment reimbursement is designed to offset increased costs associated with treating these patients. The whistleblower complaint, which was unsealed today, alleges that Freedom and Optimum improperly gamed a feature of the Medicare Advantage program known as risk adjustment, or risk scoring, which allows Medicare to make additional payments to managed-care plans based on the plan members' health-risk scores, which are calculated using patients' medical diagnoses. Patel, and Siddhartha "Sidd" Pagidipati, Freedom's former chief operating officer. Sewell, M.D., aided the United States government and the State of Florida in recovering $32.5 million over allegations of systemic Medicare and Medicaid fraud by Freedom Health and Optimum Healthcare, two large health insurers and operators of Medicare managed healthcare insurance plans based in Tampa, Florida and controlled by Dr. Constantine Cannon LLP announced today that its whistleblower client, the late Dr. Darren D.
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