Medicare Advantage Insurers Must Face False Claims Act Charges

UnitedHealth, Aetna, WellPoint and Health Net all must face claims that they violated federal law by allegedly designing internal audits of their Medicare Advantage programs to avoid reporting to the CMS that the agency may have overpaid risk adjustment payments, a federal appeals court ruled (United States v. United Healthcare Ins. Co., 2016 BL 258178, 9th Cir., 13-56746, 8/10/16).

The decision by the U.S. Court of Appeals for the Ninth Circuit reignites charges that the insurers and a related physician group failed to alert the Centers for Medicare & Medicaid Services about previously reported diagnostic codes that ...