The Villages' Top Health Provider Settles Medicare Fraud Allegations for $541.5 Million
In late August 2026, the U.S. Department of Justice announced a $541.5 million settlement with The Villages Health over allegations that it submitted false diagnosis codes to increase reimbursement under Medicare Advantage from 2020 to 2024. According to an external review cited in Healthcare Dive, by 2024 about half of the provider's patient diagnosis codes were unsupported and included conditions like severe obesity and immunodeficiency. The Villages Health notified federal authorities at year-end 2024 before filing for Chapter 11 bankruptcy in summer 2025. In July 2025, Humana’s CenterWell division acquired the operating business through a stalking-horse bid that eventually reached $68 million after an auction process approved by a bankruptcy court. The settlement is directed at The Villages Health System LLC, the pre-sale entity, and does not require direct payment from CenterWell or Humana. Instead, it establishes a nondischargeable claim in bankruptcy proceedings.
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Topics: Humana Medicare fraud settlement upcoding