Continuing Federal Focus on Medicare Advantage Fraud
This Briefing is brought to you by AHLA’s Fraud and Abuse Practice Group.
- January 10, 2024
- Mike Paulhus , King & Spalding LLP
- Taylor E. Whitten , King & Spalding LLP
- Christopher C. Jew , King & Spalding LLP
- Elizabeth K. Key , King & Spalding LLP
Several recent high-dollar False Claims Act (FCA) recoveries against Cigna demonstrate the Department of Justice’s (DOJ’s) continuing focus on vigorously pursuing fraud in the Medicare Advantage (MA) program, which the acting assistant chief of DOJ’s health care fraud unit has reiterated will continue. As a result, both Medicare Advantage Organizations (MAOs) and MA providers should reassess their compliance programs to ensure that the care provided to enrollees of MA plans, and risk adjustment data or diagnoses related thereto, align with the government’s expectations.
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