The Sweeping Landscape of Potential Liability For Risk Adjustment Activities: Providers and Vendors Beware, It’s Not Just a ‘Health Plan Issue’ Anymore


Risk adjustment has always been an area of potential significant False Claim Act liability for Medicare Advantage organizations and other plans. However, the growing number of False Claims Act settlements and complaints in which the Department of Justice has intervened should also raise the alarm for healthcare providers and vendors that submit risk adjustment data to plans. The ever-increasing popularity of value based and risk based contracting means even greater exposure for providers’ diagnosis coding and other risk adjustment activities. This webinar will review recent allegations and settlements under the False Claims Act relating to risk adjustment, government prosecution strategies, and the implications for plans and providers arising from the D.C. Circuit Court of Appeals’ recent reinstatement of CMS’ Part C and Part D overpayment rule.

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