The Justice Department’s scrutiny of Medicare Advantage risk adjustment is intensifying, with two recent settlements totaling nearly $1.1 billion highlighting federal concerns about diagnosis coding practices that can increase payments to health plans.
The latest came Aug. 27, when The Villages (Fla.) Health System agreed to pay $541.5 million to resolve allegations that it violated the False Claims Act by submitting improper diagnosis codes to Medicare Advantage insurers. The settlement follows Oakland, Calif.-based Kaiser Permanente’s January agreement to pay $556 million over allegations that it submitted unsupported diagnoses to increase risk-adjusted Medicare Advantage payments. ARTICLE