In the Crosshairs: Medicare Advantage and Risk Adjustment Fraud


Monday, June 12, 2017
10-10:30 a.m. ET; 7-7:30 a.m. PT

Mary A. Inman, Esq.
Constantine Cannon, LLP, San Francisco

Duane Abbey, PhD, CFP; Janelle Ali-Dinar, PhD;
Nancy Beckley, MS, MBA, CHC; David Glaser, Esq.;
Ronald Hirsch, MD, FACP, CHCQM; and Edward Roche, PhD, JD

A major lawsuit against a Medicare Advantage Organization (MAO) was reported last week by RACmonitor, when the U.S. Department of Justice announced a $32.5 million settlement with Freedom Health Inc. and Optimum Healthcare, MAOs based in Tampa, Fla.

The reported settlement resolves allegations that the insurers violated the False Claims Act by engaging in illegal schemes to maximize their payment from the government in connection with their Medicare Advantage plans. The whistleblower complaint alleged that Freedom and Optimum gamed risk-adjustment frameworks used by the Centers for Medicare & Medicaid Services (CMS) to make extra payments to MAOs for sicker patients or patients with multiple chronic conditions. Reporting this major story will be Monitor Mondays’ special guest Mary Inman, partner in the whistleblower practice group at Constantine Cannon, LLP in its San Francisco office and one of the lead attorneys representing the whistleblower in this case.   

The broadcast rundown also includes:

  • Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will be making his Monday Rounds with another installment of his popular segment.

  • Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, will have all the latest hot topics and the Monitor Mondays Listener Survey.

  • America’s Rural Health Report: Topic authority Janelle Ali-Dinar, vice president of rural health for MyGenetx, will report on saving healthcare for rural populations.

  • Ransomware Crisis: RACmonitor investigative reporter Edward Roach, founder and director of scientific intelligence for Barraclough NY LLC, will continuing his reporting on the global ransomware crisis facing America’s hospitals.

  • Medicare Advantage Report: Author, educator and consultant Duane Abbey, president of Abbey & Abbey Consultants, Inc., will preview part two in his webcast series on Medicare Advantage and the use of risk adjustment in either paying or denying claims.

  • Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron will return with another example of a potentially troublesome issue that could pose a risk to your facility.

Register now for this news broadcast coming your way on Monday, June 12, 2017 at 10 a.m. ET.

Monitor with us.™