Martin's Point Health Care Risk Adjustment Settlement

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Jul 31, 2023, 15:19 ET

PORTLAND, Maine, July 31, 2023 /PRNewswire/ -- Today, Martin's Point Health Care announced that it has agreed to a settlement with the U.S. Department of Justice (DOJ) to resolve an investigation related to Martin's Point's Risk Adjustment practices for the payment years 2016-2019. The claims resolved by the settlement are allegations only, and there has been no determination of liability. The settlement is not related to member care or the payment of member claims.

Martin's Point worked collaboratively with the DOJ during the course of the investigation. Despite denying liability for the litigation claims at issue, Martin's Point ultimately determined that settlement of this matter was appropriate rather than engaging in the cost and uncertainty of protracted litigation.

A spokesperson for the organization commented: "This settlement is not an admission of liability, it instead allows us to avoid the disruption, expense, and uncertainty of litigation. It is important to note that this investigation is unrelated to member care or payment of member claims. This resolution allows us to put the past behind us, and we remain committed to our patients and members across our service regions and to the regulatory agencies that oversee our work."

Martin's Point Health Care is committed to the integrity of our work, mission, and service to our patients and members. Since 2019, Martin's Point has taken steps to strengthen and develop new Risk Adjustment processes. Additionally, under the direction of new executive and senior leadership, the organization has established a team of experienced personnel specifically tasked with oversight of all Risk Adjustment practices. Martin's Point will continue to devote additional resources to ensuring compliance with all regulatory requirements.

About Martin's Point Health Care
Martin's Point Health Care is a not-for-profit organization based in Portland, Maine. Martin's Point provides primary and specialty care at their Health Care Centers in Southern Maine and Portsmouth, New Hampshire. They also offer Medicare Advantage plans in Maine and New Hampshire and TRICARE Prime health plans serving military retirees and the families of active-duty military in Maine, New Hampshire, Vermont, New York, and Pennsylvania. Visit www.MartinsPoint.org for more.