Medicare Advantage Plans Under Siege: Another Whistleblower Lawsuit

Event Date: 4/19/2017

Event Overview

Webinar event: 1:30PM CT - 3PM CT

Session description:

Recent regulatory action represents a significant risk for Medicare Advantage Plans and underscores the importance of completing a comprehensive review of your organization’s overall approach to the HCC-RAF risk adjustment process in order to understand potential exposure.

In addition to the Swoben v. United Healthcare court federal False Claims Act (FCA) decision last year, which brought attention to Medicare Advantage HCC-RAF retrospective review practices, another federal FCA qui tam whistleblower lawsuit has been unsealed in the case of United States ex rel Benjamin Poehling v. United Healthcare Group, et. al. These allegations are much broader than those in Swoben, ranging across all aspects of the defendants’ operations. Allegations include not only auditing protocols, but also provider relations, vendor oversight, code deletion processes and financial incentives to employees, vendors and providers. Medicare Advantage Plans’ approach to risk adjustment reimbursement has clearly caught the attention of both the federal government and the qui tam whistleblower bar. We can only expect more lawsuits and enforcement initiatives to come.

This webinar is focused on helping Medicare Advantage Plans to establish an informed plan of attack in response to the growing focus on the propriety of Plans’ operations:

• In light of Poehling, Swoben, and the overall regulatory requirements on Medicare Advantage Plans, what are the potential regulatory and enforcement risks?
• What operational areas may be subject to scrutiny and expose Medicare Advantage Plans to potential liability?
• How can Plans be proactive in understanding the risks, reviewing all aspects of their operations, and minimizing their exposure?
• Are traditional compliance programs sufficient to manage the risks in the expanding enforcement environment? If not, what additional steps can or should be taken?

This event is designed for:

Executive stakeholders in Medicare Advantage, and also people who have responsibility Finance, Strategy, Regulatory Affairs and Compliance

This event is hosted on our Readytalk platform.

Documents

5/1/2017

HealthScape value-added offer: MA risk adjustment compliance assessment
In April 2017, HealthScape hosted a webinar, "Medicare Advantage Plans Under Siege" regarding recent whistleblower and False Claims Act allegation in the MA market. In follow-up, HealthScape and Sheppard Mullin developed a value add service for Alliance plan members to help better prepare for compliance and audit risk.

4/19/2017

Recording: Medicare Advantage Plans Under Siege: Another Whistleblower Lawsuit
Recent regulatory action represents a significant risk for Medicare Advantage Plans and underscores the importance of completing a comprehensive review of your organization’s overall approach to the HCC-RAF risk adjustment process in order to understand potential exposure.

4/18/2017

Presentation: Medicare Advantage Plans Under Siege - Another Whistleblower Lawsuit
In addition to the Swoben v. United Healthcare court federal False Claims Act (FCA) decision last year, which brought attention to Medicare Advantage HCC-RAF retrospective review practices, another federal FCA qui tam whistleblower lawsuit has been unsealed in the case of United States ex rel Benjamin Poehling v. United Healthcare Group, et. al.