FCA Lawsuits over Risk Adjustment Continue Against Medicare Advantage Plans
This Bulletin is brought to you by AHLA’s Health Care Liability and Litigation Practice Group.
- October 29, 2020
- Steven D. Hamilton , Reed Smith LLP
Another federal False Claims Act (FCA) lawsuit relating to Medicare Advantage risk adjustment was recently unsealed in the U.S. District Court for the Southern District of New York. The case, United States ex rel. Cutler v. Cigna Corp., was filed by relator Robert Cutler in October 2017 and unsealed in August 2020. According to the unsealed complaint, the relator alleges that Cigna defrauded the government by submitting false risk adjustment data for its Medicare Advantage plans. This lawsuit is yet another FCA case against Medicare Advantage organizations (MAOs) relating to risk adjustment and demonstrates that these insurers continue to face substantial risk over risk adjustment scores.
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