News & Analysis as of

Medical Billing Codes Medicare Advantage

Bradley Arant Boult Cummings LLP

Medicare Advantage Programs’ Increasing Popularity Invites Heightened FCA and Regulatory Scrutiny

As Medicare Advantage attracts more eligible beneficiaries, it is also drawing attention from False Claims Act (FCA) prosecutors. In 2022, enrollment in Medicare Advantage plans reached 28.7 million Medicare beneficiaries, or...more

Bass, Berry & Sims PLC

SDNY Ruling in Anthem Sends a Signal to Medicare Advantage Litigants

Bass, Berry & Sims PLC on

In a decision issued on September 30, Judge Andrew Carter of the U.S. District Court for the Southern District of New York denied Anthem Inc.’s motion to dismiss a government lawsuit filed in March 2020 claiming Anthem...more

Bass, Berry & Sims PLC

Medicare Advantage Plan Highlights Distinction for FCA Purposes between Clinically Inaccurate Diagnoses and Clinically Accurate...

Bass, Berry & Sims PLC on

In a September 2022 filing in U.S. ex rel. Osinek v. Kaiser Permanente, the Kaiser Permanente consortium defendants (Kaiser) highlighted the distinction between clinically inaccurate diagnoses (factual falsity) and clinically...more

King & Spalding

OIG Publishes Report on Program Integrity Risks Related to Medicare Telehealth Services During the First Year of the Pandemic

King & Spalding on

On September 2, 2022, OIG published a report of its findings summarizing its investigation into whether providers appropriately billed for Medicare beneficiaries’ telehealth services. This report analyzed data from the...more

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