HealthSun Health Plans, Inc.

Pursuant to the Criminal Division’s Voluntary Self-Disclosure and Corporate Enforcement Policy, on October 25, 2023, the Fraud Section declined to prosecute HealthSun Health Plans, Inc. for violations of United States Code Title 18 Sections 1343, 1347, and 1349, because the company voluntarily self-disclosed the misconduct, cooperated with the government’s investigation, and timely and appropriately remediated.

As part of the agreement the company agreed to repay approximately $53 million in overpayments made by the U.S. Centers for Medicare and Medicaid Services (“CMS”).

From approximately 2015 until early 2020, HealthSun’s former Director of Medicare Riks Adjustment Analytics orchestrated a scheme to submit false and fraudulent information to CMS in order to increase the amount HealthSun received for certain of its Medicare Advantage enrollees.