Matrix Medical Network, False Claims, Texas 2023

Healthcare Giant Caught in Scandal, Ordered to Pay $56.5 Million

In a shocking turn of events, Community Care Health Network LLC, doing business as Matrix Medical Network (Matrix), DPN USA, doing business as HealthFair (HealthFair), and Shahriah “James” Ekbatani have agreed to pay a total of $56.5 million to resolve allegations that they violated the False Claims Act (FCA) by causing the submission of false or invalid diagnosis codes to the Medicare Advantage program.

The allegations against Matrix and HealthFair, a company founded and managed by Ekbatani, date back to 2014 and continued until 2019. During this period, the companies allegedly knowingly caused Medicare Advantage Organizations (MAOs) to submit false and invalid diagnoses of chronic medical conditions to the Centers for Medicare and Medicaid Services (CMS) for risk adjustment purposes.

Matrix, headquartered in Nashville, Tennessee, is a health services company that contracts with MAOs to provide in-home assessments to MA plan beneficiaries. HealthFair, which was acquired by Matrix in 2018, operated mobile healthcare buses staffed by nurse practitioners and medical technicians and fitted with certain medical equipment. It contracted with MAOs in several states to provide health assessments to MA plan beneficiaries on HealthFair buses.

Matrix will pay $36.5 million to resolve claims in a qui tam action filed in the Southern District of New York. HealthFair, which was acquired by Matrix, will pay $5 million and Ekbatani will pay $15 million to resolve claims in a qui tam action filed in the Eastern District of Texas.

The United States alleges that the defendants' actions put profit ahead of patients and undermined the integrity of the Medicare Advantage program. The case is a stark reminder of the importance of transparency and accountability in the healthcare industry.

Defendant/Respondent: Community Care Health Network LLC (doing business as Matrix Medical Network) and DPN USA (doing business as HealthFair) and Shahriah “James” Ekbatani

Exact Criminal Charges: Violation of the False Claims Act (FCA) by causing the submission of false or invalid diagnosis codes to the Medicare Advantage program

City and State: SHERMAN, Texas

Exact Date: Not provided

Sentence or Outcome: Matrix will pay $36.5 million, HealthFair will pay $5 million, and Ekbatani will pay $15 million to resolve claims

Dollar Amounts: $56.5 million total, $36.5 million (Matrix), $5 million (HealthFair), $15 million (Ekbatani)

Source: https://www.justice.gov/usao-edtx/pr/matrix-healthfair-and-healthfair-founder-agree-pay-565-million-resolve-false-claims