Recent MA Coding Complaints Signal DOJ’s ‘Evolving Expectations’

The risk adjustment system used to pay Medicare Advantage plans continues to face intensifying scrutiny from the federal government, with the Dept. of Justice (DOJ) intervening in multiple False Claims Act (FCA) complaints and the HHS Office of Inspector General focusing on retrospective chart reviews and high-risk diagnosis codes. Now, attorneys say health care providers should be on high alert as well. While prior DOJ complaints-in-intervention have focused largely on MAOs conducting “one-way” chart reviews, more recent lawsuits focus on the use of “addenda” — information retroactively added to a patient’s medical record — which one law firm says indicates a new area of scrutiny.

© 2022 MMIT

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

Related Posts

https://www.mmitnetwork.com/wp-content/uploads/2021/10/WordPress-Featured-Image-radar-on-medicare-advantage.jpg
October 7

OIG: Chart Reviews Fueled ‘Disproportionate’ MA Pay

Read More
https://www.mmitnetwork.com/wp-content/uploads/2021/11/WordPress-Featured-Image-radar-on-medicare-advantage-Industry-Groups-Get-in-Front-of-Potential-Medicare-Advantage-Cuts.jpg
November 4

Industry Groups Get in Front of Potential Medicare Advantage Cuts

READ MORE
https://www.mmitnetwork.com/wp-content/uploads/2021/08/post-default-img.jpg
September 17

Curious Cases of Eric Johnson Trouble Pa. Blues Insurer

Read More

GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND

Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today