Whistleblower accuses Aledade, largest US independent primary care network, of Medicare fraud

A Maryland firm, Aledade Inc., is facing a whistleblower lawsuit alleging Medicare fraud by using billing software to make patients appear sicker than they were, resulting in millions of dollars in improper revenues. A senior employee filed the lawsuit, claiming he was fired after objecting to the company’s practices. Aledade denies the allegations. The lawsuit also names 19 independent physician practices. This case is unique as it involves upcoding within accountable care organizations, which aim to reduce wasteful spending. Aledade allegedly encouraged doctors to add unnecessary medical diagnoses to increase payments, closely monitored coding practices, and provided questionable coding guidance.

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