U.S. News
A Florida Health Company Paid $14.1 Million After Pressuring Doctors to Add False Diagnoses to Medicare Records
By Curtis Jones · August 4, 2026
The patients didn’t have bipolar disorder. The patients didn’t have drug dependencies. The diagnoses were added anyway — because the company got paid more for sicker patients.
Complete Health Partners Holdings, a Jacksonville-based company that manages medical practices in Florida, Alabama, and Colorado, agreed to pay $14.1 million to settle allegations that it caused false diagnosis codes to be submitted to Medicare Advantage plans to inflate federal payments.
The Department of Justice said the company pushed coders and physicians to add diagnoses in two specific categories — HCC 55, covering drug and alcohol dependence, and HCC 59, covering major depressive, bipolar, and paranoid disorders — from 2020 to 2023. Prosecutors alleged many of those codes were not clinically valid, were not supported by the patients’ medical records, and were not considered in their treatment.
The financial incentive was built into the system. Medicare Advantage — the private alternative to traditional Medicare used by more than 33 million Americans — pays health plans a fixed monthly rate per enrollee. That rate is adjusted based on the patient’s diagnosed conditions. Sicker patients generate higher payments. Complete Health had contracts that gave it a share of those payments, creating what the government described as a direct financial incentive to inflate risk scores.
“Companies that attempt to improperly boost their own profits by reporting bogus medical conditions of Medicare Advantage enrollees will be held responsible for their actions.” Principal Deputy Assistant Attorney General Brian M. Boynton said.
The scheme is not unique to Complete Health. Medicare Advantage upcoding has become one of the most persistent forms of health care fraud in the country. The Justice Department has pursued dozens of similar cases in recent years, including a $98 million settlement with Independent Health in New York and a $22.6 million settlement with a Florida plan operator over the same type of diagnosis inflation.
The structure creates a system-wide incentive. When a management company earns more money for patients who appear sicker on paper, every diagnosis becomes a revenue decision as much as a medical one. The patients whose records were altered may never know — their care didn’t change, but their paperwork did.
Complete Health did not admit wrongdoing. The claims resolved by the settlement are allegations only.
“This settlement sends a strong message that our focus on this vital practice area has not wavered.” U.S. Attorney Gregory Kehoe said.
The $14.1 million recovers a fraction of what the inflated payments cost taxpayers. It doesn’t repair the records of patients who now carry diagnoses for conditions they were never treated for — and may not have had.