Valdez v. Aveta, Inc., et al.

This whistleblower complaint filed in 2011 by the former president of a Medicare Advantage plan in Puerto Rico alleges that the Medicare Advantage plan and its corporate partners engaged in systemic, intentional upcoding by inflating members' risk scores to recieve a higher capitated rate. The complaint alleges that from January 2007 through December 3, 2010, the defendants received $1.0 to $1.8 billion annually, with up to $350 million per year in payments for inflated risk scores. The defendants include Aveta, Inc., MMM Healthcare, Inc., PMC Medicare Choice, Inc., MSO of Puerto Rico, Inc., and MMM Holdings, Inc. The . . .