MMM Holdings paga $15.2 millones para resolver las acusaciones de reclamaciones falsas.
The company is required to overhaul its marketing and referral practices to comply with federal regulations.
MMM Holdings LLC has agreed to pay $15.2 million to resolve allegations that it violated the False Claims Act and the Anti-Kickback Statute, according to an announcement by the U.S. attorney for the District of Puerto Rico and the Department of Health and Human Services Office of Inspector General (HHS-OIG).
The case centers on a gift card incentive program implemented between January 2018 and December 2022, which allegedly induced improper enrollments in Medicare Advantage plans.
The U.S. government alleged that MMM distributed gift cards to administrative assistants of health care providers to encourage referrals and enrollments of Medicare beneficiaries into its Medicare Advantage plans.
These enrollments resulted in associated premium payments totaling more than $6 million. The incentive program was deemed to violate the Anti-Kickback Statute and, by extension, the False Claims Act.
“Investigating health care fraud remains a high priority in the Department of Justice, and the United States Attorney’s Office will aggressively pursue those that violate the health care laws of the United States,” said U.S. Attorney W. Stephen Muldrow.
“In this case, we appreciate MMM’s cooperation during the investigation and willingness to promptly negotiate a resolution in this matter,” he added.
Under the settlement, MMM agreed to the $15.2 million payment and entered into a five-year Corporate Integrity Agreement (CIA) with HHS-OIG. The agreement mandates that MMM develop and enforce procedures ensuring compliance with the Anti-Kickback Statute for any new or existing marketing arrangements. An Independent Review Organization will annually audit MMM’s systems and a sample of arrangements during the CIA period.
“The negotiated settlement with MMM took into consideration the company’s cooperative efforts and implementation of internal controls,” the statement noted.
The resolution underscores the government’s ongoing efforts to protect the Medicare program and ensure compliance among health care providers and insurers.
“Medicare Advantage plans that engage in improper financial arrangements undermine the integrity of the Medicare program and place profits ahead of enrollees’ best interests. HHS-OIG will continue to coordinate with our law enforcement partners to identify and investigate such allegations to protect federal health care programs and the Americans who rely on them,” said Naomi Gruchacz, special agent in charge of the New York Regional Office of HHS-OIG.
The case was prosecuted by Assistant U.S. Attorney Rafael J. López-Rivera, civil health care fraud coordinator, with assistance from HHS-OIG and the Federal Bureau of Investigation.
