Published Oct. 6, 2026, 4:18 p.m. EDT. AIDS Healthcare Foundation has agreed to pay $1.44 million to resolve federal allegations that unsupported or inaccurate diagnosis codes increased Medicare Advantage payments.
The Justice Department announced the civil settlement Tuesday. The claims are allegations only, and the department said there has been no determination of liability.
What the government alleged
AIDS Healthcare Foundation, a Los Angeles-based nonprofit, operated special-needs Medicare Advantage plans for people with HIV in California, Florida and Georgia through its Managed Care Division, doing business as Positive Healthcare Partners.
Federal officials alleged that from payment years 2017 through 2023, the organization did not promptly investigate and delete diagnosis codes that were inaccurate or unsupported by medical records. Medicare Advantage payments are adjusted using reported diagnoses, with higher expected medical costs generally producing higher payments to private plans.
The Justice Department said internal “Delete Research” spreadsheets identified codes that might lack medical-record support. It alleged that most of those codes were not deleted until 2024 or 2025, after the organization was notified of the federal investigation. The government also alleged that some HIV diagnosis codes submitted for the 2017 payment year lacked documentation from a face-to-face visit.
Whistleblower share and remediation
The case was brought under the whistleblower provisions of the False Claims Act by a former risk-adjustment coder. The department said the whistleblower will receive $259,200 from the federal recovery.
Federal officials also credited the organization for cooperation and remediation. According to the settlement announcement, AIDS Healthcare Foundation enhanced its compliance program and submitted deletions for diagnosis codes that its review found were unsupported.
The settlement resolves the specified civil claims without a court finding that the organization was liable. Readers can follow AskNovus Health News and Finance for verified healthcare-policy and enforcement developments.
Featured image: Photo by CDC on Unsplash. Image is illustrative.