A former Medicare Advantage executive has been found not guilty of healthcare fraud.
A jury found Kenia Valle Boza, the former director of Medicare risk adjustment analytics for HealthSun Health Plans, not guilty of one count of conspiracy to commit healthcare fraud and wire fraud, and three counts of major fraud against the U.S., according to court documents.
The Department of Justice alleged Ms. Boza orchestrated a scheme to submit fraudulent and false information to CMS to increase the reimbursement HealthSun received from the federal government.
The department declined to prosecute HealthSun, which was acquired by Elevance Health in 2017, because of the organization’s “prompt voluntary self-disclosure, cooperation, and remediation,” according to a 2023 news release. The company also agreed to pay $53 million in repayments to the government.
Criminal prosecutions of Medicare Advantage fraud are rare, according to a June 17 news release from law firm McDermott Will & Emery, which represented Ms. Boza.
“It took the jury only four hours to vindicate our client of these baseless charges, and to let her move on from this nightmare,” attorney Franklin Monsour Jr. said.
