December 20, 2019
By Timothy Powell, CPA CHCP Special Bulletin: OIG Looks at Medicare Advantage Risk Score Audits
MAOs use chart reviews to increase risk-adjusted payments is seen as inappropriate by the OIG. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a study that should cause a chill to run down the spines of hospital and Medicare Advantage plan leaders alike.…
June 14, 2018
By Mary Inman, Esq. and Max Voldman, Esq. Aetna Whistleblower Sues CVS’s Pharmacy Benefit Management Division for Spread Pricing
The whistleblower brought this suit under the federal False Claims Act. In February 2014, whistleblower Sarah Benhke, the former senior Medicare Part D actuary at Aetna, filed a sealed complaint against CVS Caremark, the pharmacy benefit management department of healthcare giant CVS Health, accusing the company of billing Medicare Part…
March 22, 2017
By Duane Abbey, PhD, CFP RAC Integration for Medicare Advantage Audits
Section 6411(b) of the Patient Protection and Affordable Care Act of 2010 (PPACA) requires the expansion of the Recovery Audit Contractor (RAC) program to Medicare Part C. While we may refer to either MA as Medicare Advantage (or a more accurate acronym, MAO, for Medicare Advantage Organizations), the simple fact…