A Modern Healthcare article titled, “Were Patients Really Sicker?” and published on Nov. 24 (print) and Nov. 22 (online), quotes government enforcement partner Kirsten Mayer (Boston) concerning pending qui tam cases alleging that insurers knowingly benefit from the over-diagnosis of Medicare Advantage patients in order to receive higher monthly payments from CMS.
Kirsten Mayer commented on the growing number of cases alleging risk-adjustment fraud and the industry’s likely response, saying “In my experience, when you see a concentration of False Claims Act litigation on a particular theory, what you see is the industry focus on what they’re doing to comply with the law.”
