risk scores

Latest Headlines

Latest Headlines

Government audits reveal millions in Medicare Advantage overpayments

Four more secret Medicare Advantage audits surfaced Friday thanks to a Freedom of Information Act lawsuit filed by the Center for Public Integrity. The most recent government audits add to the growing concern that significant billing errors and inflated risk scores contribute to millions in overpayments.

Following $450 million settlement, DaVita subpoenaed for Medicare Advantage coding

Nearly two months after DaVita Healthcare announced it would pay nearly half a billion dollars to settle claims that it improperly billed Medicare for wasted vials of medication, the largest dialysis provider in the country is facing a subpoena from the U.S. Department of Health and Human Services (HHS), according to a Securities Exchange Commission (SEC) filing released by the company on Wednesday.

New estimates say Medicare Advantage inflated risk scores cost $2 billion a year

Medicare Advantage plans could have a problem with risk scores that are manipulated by insurers to get a higher reimbursement, according to a  Bloomberg Business  article. Experts says inflated risk scores cost Medicare $2 billion in 2014. 

Government audit reveals UnitedHealth Group Medicare Advantage plan overbilling

A government audit obtained by the Center for Public Integrity revealed claims that UnitedHealth Group, the nation's largest Medicare Advantage provider, overbilled the government $381,776 in a small sample of cases. UH appealed the decision and denounced the audit--a three-year secret legal battle ensued. 

Second senator calls for Medicare Advantage oversight

A week after Sen. Chuck Grassley (R-Iowa) called on the Department of Justice and the Centers for Medicare & Medicaid Services to investigate fraud and abuse within Medicare Advantage plans, another senator from the other side of the aisle reaffirmed the need for improved federal scrutiny.

Sen. Chuck Grassley calls DOJ, CMS to task on Medicare Advantage payments

Sen. Chuck Grassley (R-Iowa) wants to know how the Department of Justice and the Centers for Medicare and Medicaid Services are addressing the  billing problems that have plagued Medicare Advantage for years.

More whistleblower lawsuits target Medicare Advantage plans

At least six whistleblower lawsuits have been filed in states across the country alleging overpayments linked to privately run Medicare Advantage plans, and more are expected to emerge.

DOJ investigating Humana's Medicare Advantage billing process

The Department of Justice has requested information from Humana regarding risk adjustments assigned to Medicare Advantage beneficiaries, according to an annual report the insurance company filed to the Securities and Exchange Commission.

Florida fraud case highlights concerns surrounding Medicare Advantage upcoding

In what is believed to be the first case of its kind in South Florida, prosecutors are pursuing criminal fraud charges against a physician that overcharged Medicare Advantage plans. The case has pulled the health plan into the spotlight as it attempts to stave off spending cuts.

Another alleged rip off linked to Medicare Advantage risk scores

Anita Silingo, former compliance officer at Mobile Medical Examination Services, Inc., filed a lawsuit accusing the company of falsely diagnosing medical conditions that resulted in Medicare Advantage plans overcharging the government at least $1 billion, The Center for Public Integrity reported.