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False Claims Act (FCA) › Aetna

Sheppard Mullin Richter & Hampton LLP

Medicare Advantage Plans Under Fire: The Department of Justice Files Complaints-in-Intervention

Sheppard Mullin Richter & Hampton LLP on

As reported in earlier blogs, the federal Department of Justice (DOJ) has been actively looking into potential abuses by Medicare Advantage (MA) Organizations as to allegedly improper risk adjustment claims submissions and...more

Sheppard Mullin Richter & Hampton LLP

The Siege Continues: The Justice Department Is Investigating Four Additional Medicare Advantage Plans On Risk Adjustment Issues

Sheppard Mullin Richter & Hampton LLP on

WHO IS AT RISK - The federal government has indicated that it is still investigating, and could ultimately join a false claims whistleblower qui tam action against Aetna, Inc., Humana, Inc., Cigna, Inc. (through its Bravo...more

Mintz - Health Care Viewpoints

Lessons Learned from FCA Settlement Involving Waiver of Medicare Coinsurance Amounts

Mintz - Health Care Viewpoints on

The waiver of copayments, coinsurance, and deductibles owed by patients treated by out-of-network laboratories and other providers is a hot topic in the health care industry. Despite the near absence of clear legal...more

BakerHostetler

Insurer Actions Cut the Heart Out of Out-of-Network Providers

BakerHostetler on

Aetna Life Insurance Company recently won a $37 million verdict against a group of Northern California surgical centers, Bay Area Surgical Management, LLC and its affiliates (collectively, Bay Area), for an alleged...more

Mintz - Health Care Viewpoints

Laboratories – 2015 Year in Review [VIDEO]

Mintz - Health Care Viewpoints on

Over the past year, significant regulatory changes began to take shape that will have lasting effects on the laboratory industry for years to come. After publishing draft guidance regarding the regulation of laboratory...more

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