Risk Adjustment & Attribution
Expert articles and analysis related to risk adjustment & attribution.
AI Summary — Last 7 Days
DOJ/OIG risk-adjustment enforcement intensified this week as Complete Health agreed to pay $14.1M to resolve False Claims Act allegations that it pushed unsupported Medicare Advantage diagnoses to CMS, reinforcing that MA-aligned VBC providers—not just plans—face direct liability for coding-driven revenue strategies (OIG settlement). The pattern is a widening compliance perimeter around diagnosis capture, chart review, and physician incentives at the same time CMS is advancing mandatory payment-model activity in other sectors, including a nationwide joint-replacement model.
Related Articles
Complete Health to pay $14M to settle Medicare Advantage fraud allegations
The value-based primary care provider submitted false diagnosis codes to the CMS for three years, inflating its reimbursement by millions of dollars, according to the DOJ.
Research from University of Southern California Reveals New Findings on Dementia (Heterogeneous responses to risk-adjustment reform: evidence from dementia diagnosis in Medicare Advantage): Neurodegenerative Diseases and Conditions – Dementia
Research from University of Southern California Reveals New Findings on Dementia (Heterogeneous responses to risk-adjustment reform: evidence from dementia diagnosis in Medicare Advantage): Neurodegen...
Complete Health Partners Holdings $14M FCA Settlement: Medicare Advantage Risk-Adjustment Fraud
Complete Health Partners Holdings $14M FCA Settlement: Medicare Advantage Risk-Adjustment Fraud  The National Law Review
Complete Health to pay $14.1M in Medicare Advantage coding misuse allegations settlement
Complete Health to pay $14.1M in Medicare Advantage coding misuse allegations settlement  Fierce Healthcare
Florida MA provider pays $14.1M after allegedly pushing physicians to add unsupported diagnoses - beckersasc.com
Florida MA provider pays $14.1M after allegedly pushing physicians to add unsupported diagnoses  beckersasc.com
Complete Health agrees $14.1 million False Claims Act settlement over Medicare Advantage coding
Complete Health agrees $14.1 million False Claims Act settlement over Medicare Advantage coding  Traders Union
Medicare Advantage provider to pay $14.1M to settle false diagnosis code allegations - beckerspayer.com
Medicare Advantage provider to pay $14.1M to settle false diagnosis code allegations  beckerspayer.com
U.S. Court in Maryland Allows FCA Whistleblower Action Alleging Upcoding Scheme
U.S. Court in Maryland Allows FCA Whistleblower Action Alleging Upcoding Scheme  American Health Law Association
Complete Health to pay $14M to settle Medicare Advantage fraud allegations
Complete Health to pay $14M to settle Medicare Advantage fraud allegations  Healthcare Dive
ACA Marketplace Insurer Exits Are Reshaping the Market. Here’s How Health Plans Should Respond.
Opportunity After Exit: Strategic Responses to ACA Exits Key Takeaways Health insurers participating in the individual Affordable Care Act (ACA) Marketplace are facing one of the most challenging oper...