Matrix Medical Network Pays $36.5 Million To Settle Medicare Fraud Suit

NEW YORK, June 3, 2026 — The United States announced a $36.5 million civil settlement with Community Care Health Network LLC, doing business as Matrix Medical Network, to resolve a Medicare fraud lawsuit, the Department of Justice said Wednesday.

Matrix, headquartered in Nashville, Tennessee, contracts with Medicare Advantage Organizations to conduct in-home health assessments of Medicare patients. The company allegedly submitted diagnosis codes to MAOs that were not supported by the patients' medical records. Those codes in turn caused the MAOs to receive inflated risk-adjustment payments from Medicare.

The settlement covers conduct that affected payments across the Medicare Advantage program, which now covers more than 30 million beneficiaries. Medicare Advantage Organizations received roughly $450 billion in 2025 payments adjusted by diagnosis data submitted from contractors including Matrix.

Under the agreement, Matrix will pay the $36.5 million to the United States. The company did not admit liability. The settlement resolves a lawsuit filed under the False Claims Act in the Southern District of New York.

The payment takes effect immediately upon execution of the settlement agreement. Matrix must also implement enhanced compliance measures for diagnosis coding and documentation in future assessments, though specific timelines for those changes were not detailed in the announcement.

Downstream, the resolution frees Department of Justice and HHS Office of Inspector General resources previously dedicated to this investigation. It also triggers mandatory reporting of the settlement to state regulators and Medicare Advantage plans that contracted with Matrix.

Those plans must now reassess their own risk-adjustment compliance controls to avoid similar liability. The Centers for Medicare and Medicaid Services will receive its share of the recovery, which it can apply to the Medicare Trust Fund.

This is the latest in a series of False Claims Act recoveries targeting Medicare Advantage risk-adjustment practices. The Justice Department has pursued similar cases against health-assessment vendors and MAOs since at least 2020, focusing on unsupported hierarchical condition category codes that increase capitated payments.