Shumaker Manufacturing

A Legal & Industry Review

Feds Shine a Light on Medicare Advantage Plans and Physicians Related to Risk Adjustment Practices

Although the sufficiency of medical records documentation supporting beneficiary diagnoses for Medicare Advantage (MA) risk adjustment has been on the OIG’s work plan since 2013, the Department of Justice has upped the ante with a 2016 physician criminal conviction and recent intervention in two qui tam cases related to MA risk adjustment. These initiatives allege that MA plans made false claims by submitting diagnoses for risk adjustment that were unsupported by medical documentation or medical condition and that both insurers and providers engaged in a variety of questionable practices.

Follow the link to read more of the Client Alert, “Feds Shine a Light on Medicare Advantage Plans and Physicians Related to Risk Adjustment Practices”, authored by partner Kelly A. Leahy and associate Rachel B. Goodman of Shumaker, Loop & Kendrick, LLP.

Comments are closed.