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 […]

Securities and Exchange Commission Joins False Claims Act Investigation Against KBR

Over the past year, we have examined a False Claims Act case against one of the largest military contractors in the world: Kellogg, Brown & Root. Known as KBR, this firm has been awarded over $40 billion in government work throughout the Iraq and Afghanistan wars, primarily for logistical support. […]

Shell Oil Company Pays to Settle Allegations of False Claims for Environmental Clean-Up

In a recent case out of Massachusetts, oil giant Shell has agreed to pay $4 million to the Commonwealth in order to settle claims it improperly billed for environmental cleanup services. We have reported in the past on the importance of state-level false claims acts, which often work to supplement […]