Tag

Risk Adjustment

All articles tagged with #risk adjustment

Kaiser Permanente to pay $556 million to settle Medicare Advantage fraud allegations
business1 month ago

Kaiser Permanente to pay $556 million to settle Medicare Advantage fraud allegations

The Justice Department announced a $556 million settlement with Kaiser Permanente over allegations that it inflated Medicare Advantage payments by adding improper diagnoses to patient charts after visits, a practice the government says diverted about $1 billion from taxpayers between 2009 and 2018; Kaiser says the settlement resolves the matter without admitting wrongdoing and notes it concerns risk-adjustment practices rather than care quality.

Grassley accuses UnitedHealth of turning Medicare Advantage risk scoring into a profit engine
politics1 month ago

Grassley accuses UnitedHealth of turning Medicare Advantage risk scoring into a profit engine

A Senate majority staff report based on more than 50,000 pages alleges UnitedHealth Group uses aggressive diagnosis capture, in-home health risk assessments, and coding guidance to inflate Medicare Advantage risk scores and in turn receive higher CMS payments. The findings describe a specialized workforce and data capabilities that adapt to CMS crackdowns, with examples like diagnoses for opioid dependence, alcohol use disorders, and dementia, and warn that the company sells its criteria to other MAOs, potentially impacting taxpayers and the integrity of the MA program. The report follows Grassley’s long history of MA oversight and calls for continued scrutiny of risk-adjustment practices.