Tag Archives: medicare advantage

Exaggerated Diagnosis Codes and Inadequate Provider Networks: Allegations of Medicare Advantage Fraud Settled for $32.5 Million

By Kevin Bradberry on June 20, 2017 Posted in Uncategorized

The latest settlement involving Medicare Advantage (MA) organizations highlights not only the government’s continuing enforcement focus on Medicare Part C but also the vulnerabilities inherent in that program. In United States ex rel. Sewell v. Freedom Health, Inc. et al., two Florida-based MA organizations – Freedom Health and Optimum HealthCare – agreed to pay $32.5 … Continue Reading

The DOJ Enters Another FCA Lawsuit Against UnitedHealth

By B. Scott McBride and Jennifer Whitton on May 30, 2017 Posted in Uncategorized

The U.S. Department of Justice (DOJ) recently filed its complaint in intervention in another whistleblower lawsuit brought under the False Claims Act against the nation’s largest owner and operator of Medicare Advantage (MA) organizations, UnitedHealth Group, Inc. (United). The DOJ’s 39-page complaint alleges that United had fraudulently obtained inflated risk adjustment payments by over reporting diagnosis … Continue Reading

CMS Fines Insurer for Misleading Medicare Part D Beneficiaries

By Lee H. Rosebush and Dena Kessler on April 20, 2015 Posted in Uncategorized

The federal agency that oversees Medicare’s prescription drug program has alleged that a major U.S. insurance company misled beneficiaries about the pharmacies included in the company’s drug plan, and imposed a $1 million fine. According to a civil monetary notice issued by the Centers for Medicare and Medicaid Services (CMS), Aetna Inc. improperly reported that … Continue Reading

Medicare Advantage and Medicare Part D Changes for 2016 Released

By Nita Garg and Lee H. Rosebush on March 5, 2015 Posted in Uncategorized

On February 6, 2015, the Centers for Medicare & Medicaid Services (CMS) released a final rule regarding changes to Medicare Advantage and Medicare Part D to take effect in 2016. According to CMS, this final rule “implements statutory requirements, improves program efficiencies, strengthens beneficiary protections, clarifies program requirements, improves payment accuracy, and makes technical changes … Continue Reading