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Lawsuits Allege Inflated Risk Adjustment Scores, Resulting in False Claims

In yesterday’s post, we introduced the concept of risk assessment scores, and how the Center for Medicaid and Medicare Services (CMS) relies on information reported by healthcare facilities to adjust reimbursement rates [1. Medicare Managed Care Manual, Chapter 7. http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/mc86c07.pdf] for certain demographics and regional areas. As a review, certain […]

Courts Considering Concept of Inflated ‘Risk Adjustment Scores’ Under the False Claims Act

According to a report published by the Center for Public Integrity, as many as six separate whistleblower lawsuits have been filed since 2010 alleging inflated ‘risk adjustment scores’ submitted to the Center for Medicare and Medicaid Services (CMS). This paradigm shift in alleging false claims centers on the notion that […]

Hamilton Healthcare Accused of Allowing Excluded Practitioner to Treat Medicare and Medicaid Patients

As a healthcare practitioner, permission to work with Medicaid and Medicare participants can be an extremely lucrative area of practice. For many physicians working in areas with an aging or low-income demographic, government healthcare enrollees can quickly become a large majority of the patient load – which can often invite […]

Watry Homes, LLC, Accused of Underpaying Workers on Government Housing Projects

In today’s post, we explore a form of trickery involving underpayment of workers tasked with constructing federally-funded housing in the Milwaukee, Wisconsin, area. Watry Homes, LLC, has settled both civil and criminal charges stemming from a massive payroll fraud scheme costing taxpayers millions of dollars and resulting in the extreme […]

Tulsa Doctor and Clinic to Settle Allegations of Medicare Fraud for $105,000

In today’s post, we will explore a recent $105,000 settlement involving a Tulsa, Oklahoma, physician accused of defrauding the taxpayer-funded Medicare system, which serves millions of Americans aged 65 and older with affordable health insurance coverage.[1. Department of Justice Press Release, “Settlement Reached In Medicare Fraud Lawsuit Against Tulsa Doctor And […]