The Department of Justice announced in a press release last month that Skyline Urology has agreed to pay the United States $1.85 million to resolve allegations that it violated the False Claims Act by submitting improper claims to the Medicare program for evaluation and management services.
Physician Group to Pay $1.85 Million to Settle False Claims Act Allegations of Medicare Overbilling
DOJ Joins Whistleblower Lawsuit Accusing Health System of Submitting Unsupported Diagnosis Codes
As the share of Medicare beneficiaries enrolled in Medicare Advantage has steadily grown to over 19 million beneficiaries according to a U.S. Attorney, federal prosecutors intervening in a newly unsealed whistleblower lawsuit in California is yet another example of the government's willingness to protect the integrity of the Medicare Advantage program through the courts.
DaVita Subsidiary Settles Risk Adjustment Billing Case for $270 Million
Modern Healthcare reported recently that DaVita Medical Holdings will pay a $270 million settlement to the federal government over allegations that the company incorrectly inflated certain Medicare Advantage reimbursements above the fixed, risk-adjusted rate owed for care.
Proposed CMS Risk-Adjustment Changes Could Lower Medicare Advantage Revenue
Modern Healthcare reported in a recent article that health insurer and provider groups were complaining about the CMS' proposal to use more patient encounter data to determine Medicare Advantage plans' risk scores in 2019, saying the data could reduce payments for plans.