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Risk Adjustment Fraud

This archive displays posts tagged as relevant to risk adjustment fraud in managed care programs You may also be interested in our pages:

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Medicare Advantage Plan Loses Members, Responds with Plans to Raise Risk Adjustment Scores

Posted  09/21/15
The Compliance & Ethics Blog (September 21, 2015) Click here to read the article.

Medicare Part C: Fighting Back Against Risk Adjustment Fraud

Posted  06/26/15
Health insurance companies that participate in the Medicare Managed Care program (also known as Medicare Advantage or Medicare “Part C”) routinely complain about cuts to their reimbursement rates – even in years, like this one, where the reimbursement rates are actually increased.  At the same time, reports indicate that insurers are “leaning heavily on their Medicare business” and “signal[ing their]...

Beyond RADV: Does Your Plan's Risk Adjustment Strategy Run Afoul of the False Claims Act

Posted  02/13/12
CC Attorney Mary Inman
Presented at the HCCA Managed Care Compliance Conference (February 13, 2012).  Click here to view the presentation.
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