This week, the Department of Health and Human Services (HHS) announced that it will target fraud in the Medicaid and Medicare Advantage programs, and more MA insurers filed suit seeking to increase their star ratings bonuses.
The HHS Office of Inspector General announced it had generated $5.6 billion in "monetary impact" from...
The Centers for Medicare and Medicaid Services (CMS) has issued a final rule that will increase the amount federal authorities can recoup from Medicare Advantage organizations (MAOs) that were overpaid due to incorrect diagnostic coding.
The Medicare Risk Adjustment Data Validation (RADV) final rule means that CMS will also stop...
As seniors, the Centers for Medicare and Medicaid Services (CMS) and Medicare Advantage (MA) plans gear up for a landmark Medicare Advantage Open Enrollment Period beginning October 15, Medicare Advantage on the whole is in hot water.
Last week, the New York Times published an earthshaking story documenting the extent to which...
As the Biden administration promised, the U.S. Department of Health Services (HHS) Office of Inspector General (OIG) is sifting through claims submitted by Medicare Advantage (MA) plans, looking for fraudulent activity.
The OIG published two audits this week on Medicare Advantage Compliance of diagnostic codes submitted to the Centers...National News
Medicare Advantage (MA) is a tremendously popular program among not only beneficiaries but the policymakers and stakeholders who want to see the program work out. As an alternative to Traditional Medicare, hundreds of billions of dollars flow through MA plans, leaving a lot of room for fraud.
One major source of overcharging the...National News
While Medicare Advantage plans are rapidly gaining steam and moving far faster than predicted to cover over half of eligible Medicare beneficiaries, watchdog scrutiny is ramping up to identify and curb predatory practices that may be harming beneficiaries and the bottom line of the Medicare program.
Last week, the U.S. House Committee...
This month has been busy for insurance fraud claims both big and huge, from the U.S. Department of Justice (DOJ) intervening on a False Claims Act suit to the State of Pennsylvania's Medicaid program finding fault with Aetna to former players in the National Football League (NFL) defrauding the NFL Player's association retirement health...
The U.S. Department of Justice has joined a series of six lawsuits that allege Kaiser Permanente knowingly submitted false Medicare Advantage claims. Kaiser allegedly pressured physicians to create addenda to medical records to add risk-adjusting diagnoses that patients did not actually have, were not considered or addressed during a...
