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.
Topics: HCC Coding, Risk Adjustment
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.
Topics: Medical Coding, HCC Coding, Medical Coding Audits, Risk Adjustment
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.
Topics: Medical Coding, HCC Coding, Coding Compliance, Medical Coding Audits, Risk Adjustment
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.
Topics: Medical Coding, HCC Coding, Outsourcing, Risk Adjustment
