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July 21, 2015
General
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 […]
July 20, 2015
General
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 […]featured investigations
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