August 27, 2026

Tennessee-based home care company, Monogram Health, has agreed to pay $2.4M to settle Medicare Advantage upcoding allegations from 2021 to 2023. The company allegedly submitted codes for protein-calorie malnutrition, substance use disorder, coagulation, blood disorders, and angina. These submissions were not clinically accurate as they were found unsupported by patients’ medical records and unaccompanied by patient care.

This article explores the government's allegations, the role of whistleblowers and Medicare risk adjustment practices, and what one of the largest settlements of its kind could mean for compliance, oversight, and accountability across the Medicare Advantage industry.

The study highlights the rapidly increasing volume and cost of No Surprises Act arbitration cases, prompting renewed discussion about whether legislative or regulatory changes are needed to better align the IDR process with the law's original cost-containment goals while maintaining patient protections.

The article underscores how insurers are adapting differently to utilization and cost pressures across MA and ACA markets. While MA margins appear to be stabilizing through pricing and product changes, ACA markets face greater uncertainty due to enrollment declines and a changing risk pool.

CEO George Miller was indicted in late 2024 alongside the hospital’s chief financial officer and chief transformation officer, as well as the owner of multiple vendor medical supply companies. He was accused of embezzling over $15 million from the hospital toward accounts controlled by the vendor in exchange for about $776,300, according to court documents from the indictment.