The Justice Department says AIDS Healthcare Foundation has agreed to pay $1.44 million to resolve allegations that it violated the False Claims Act by submitting or failing to delete false or invalid diagnosis codes tied to Medicare Advantage payments.
The settlement announced Oct. 6, 2026, covers payment years 2017 through 2023. DOJ says the allegations center on diagnosis codes that were inaccurate, unsupported by medical records, or not documented the way Medicare Advantage rules require.
The department also says the case came from a qui tam complaint filed by former AHF risk adjustment coder Donna Irons, who will receive $259,200 as her share of the federal recovery. DOJ says the claims are allegations only and there has been no determination of liability.
