Medicare Advantage Plan Loses Members, Responds with Plans to Raise Risk Adjustment Scores
Posted 09/22/15
By Tim McCormack and Molly Knobler (published on The Compliance & Ethics Blog)
Modern Healthcare recently reported that although enrollment in the Medicare Managed Care Program (also known as Medicare Advantage or Medicare Part C) has grown by 8% on average since 2010, several top Medicare Advantage Plans are losing membership. Highmark, Blue Cross and Blue Shield of North Carolina, HealthNow New York, Wellcare...
By Tim McCormack and Molly Knobler (published on 
By the C|C Whistleblower Lawyer Team
This week's Department of Justice "Catch of the Week" goes to Tennessee-based non-profit hospice care provider Alive Hospice, Inc. Yesterday, the DOJ announced the company paid roughly $1.5 million to reimburse the government for alleged violations of the False Claims Act through overbilling of Medicare and TennCare for hospice services. See 
By 
(published on the 
By 
by 
As far as purveyors of all things pharmaceutical go, Walter White isn’t looking so bad these days. Well, at least his prices were competitive. With major pharmaceutical companies putting astronomical and ever-increasing price tags on frequently life-saving medications, patients and insurers, including state and federal government payers, are finding themselves looking for new options and opportunities to...
Fraud in the Medicare Part D prescription drug program is getting the attention of not only the Department of Health and Human Services’ Office of the Inspector General (HHS OIG) but also watchdogs on Capitol Hill. On Tuesday, July 14, 2015, the House of Representatives’ Committee on Energy and Commerce held a hearing to examine 
By the C|C Whistleblower Lawyer Team
Last Friday, the Department of Justice secured a 45-year prison sentence against the now infamous Detroit-area doctor, Farid Fata. He was also ordered to forfeit $17.6 million of illegal reimbursements he obtained from Medicare and private insurance companies. This stems from his guilty plea in September 2014 to violating the False Claims Act with a health care fraud scheme...