Another whistleblower suit alleges Medicare Advantage fraud

California litigation targets 'house calls' that allegedly resulted in false diagnoses

by Fred Schulte for the Center for Public Integrity
October 29, 2014

A new whistleblower lawsuit accuses a California health care firm of diagnosing “false and fraudulent” medical conditions that several Medicare Advantage plans allegedly used to overcharge the federal government by $1 billion or more.

The suit was filed by Anita Silingo, a former compliance officer for Mobile Medical Examination Services, Inc., or MedXM. The Santa Ana, California-based firm sends medical professionals to the homes of Medicare Advantage members to assess their health.

Silingo claims she was fired last year after she tried to stop MedXM from exaggerating how sick these patients were, which raised government payments to the health plans. The suit, filed in August 2013 in California, was unsealed by a judge late last month.

The suit also names four Medicare Advantage insurance plans which, Silingo alleges, “turned a blind eye” to the practices. The health plans named in the suit are: Molina Healthcare of California; WellPoint, Inc., which operates  Anthem Blue Cross and Blue Shield; Health Net of California, Inc. and Alameda Alliance for Health.  None would comment.