New York Times Covers “Cash Monster” of Risk Adjustment Fraud, Featuring Cases Initiated by Constantine Cannon Clients
Posted 10/11/22
Managed Care
This archive displays posts tagged as relevant to managed care and fraud in managed care programs and services. You may also be interested in our pages:
DOJ Announces $5.7 Billion in FCA Recoveries in Fiscal Year 2021, with Boost from Purdue Settlement Claim
Posted 02/2/22
Catch of the Week: CMS Suspends UnitedHealth and Anthem Medical Advantage Plans for Charging Too Much in Premiums
Posted 09/24/21
U.S. Pursuit of Risk Adjustment Fraud Continues with Complaint in Intervention in Case Filed by Constantine Cannon Client against Independent Health and its Coding Subsidiary DxID
Posted 09/16/21
Constantine Cannon Attorneys Present on Whistleblower Cases Involving MA Risk Adjustment Fraud at RISE West Conference
Posted 09/10/21
Sutter Health – Healthcare Fraud/Medicare Advantage ($90 million)
Constantine Cannon represented a whistleblower in a False Claims Act case alleging Sutter Health and its affiliates inflated the number and severity of Medicare Advantage patient diagnoses, manipulated patient records, ignored audit red flags, and engaged in other misconduct to increase patient risk scores and obtain Medicare Advantage payments to which they were not entitled. In August 2021, Sutter agreed to pay $90 million to settle the matter, the largest Medicare Advantage False Claims Act settlement to date against a hospital system, and at the time, the second largest reported Medicare Advantage fraud settlement ever. Our client received a whistleblower award of roughly $22 million. Read more -- AP, Reuters, SF Chronicle, DOJ, PR Newswire, CC.August 30, 2021
Northern California healthcare provider Sutter Health and its affiliated entities will pay $90 million to resolve a False Claims Act case initially filed by whistleblower Kathy Ormsby alleging that defendants submitted unsupported diagnosis codes for patients enrolled in Medicare Advantage. Sutter contracts with Medicare Advantage Organizations to provide care to Medicare Advantage beneficiaries enrolled in their plans, and allegedly caused those MAOs to submit to Medicare inaccurate and invalid diagnosis codes that inflated the risk scores of those beneficiaries and were not supported by the medical records, thereby resulting in overpayments by CMS. Sutter also allegedly failed to take sufficient corrective action when it became aware of the submission of these unsupported diagnosis codes. Sutter also entered into a five-year corporate integrity agreement. Sutter previously entered into a partial settlement of $30 million, which will be credited against the $90 million total settlement. DOJ; USAO ND CalManaged Care Risk Adjustment Enforcement Continues with Sutter Health Settlement: Constantine Cannon Client Secures Largest Ever Medicare Advantage Settlement by a Hospital
Posted 08/30/21
Media Coverage of Government Intervention in Kaiser Medicare Advantage Suits: LA Times says Cases Point to a “Massive Fraud Problem in Medicare”
Posted 08/6/21
United States Reaches a “Tipping Point” in Managed Care Enforcement: DOJ Intervenes in Constantine Cannon’s Lawsuit Against Kaiser Permanente
Posted 07/30/21
