CMS’ Medicare Benefit Policy Manual
The Medicare Benefit Policy Manual is published online by the U.S. Centers for Medicare & Medicaid Services, or CMS. Its used by health care providers, contractors, Medicare Advantage companies and…
This case highlights concerns about overbilling practices within Medicare Advantage plans, where regulators struggle to prevent inflated claims. The whistleblower, Teresa Ross, will receive a portion of the settlement for her role in exposing the fraud
A western New York health insurance provider for seniors and the CEO of its medical analytics arm have agreed to pay a total of up to $100 million to settle Justice Department allegations of fraudulent billing for health conditions that were exaggerated or didn’t exist.
Independent Health Association of Buffalo, which operates two Medicare Advantage plans, will pay up to $98 million. Betsy Gaffney, CEO of medical records review company DxID, will pay $2 million, according to the settlement agreement. Neither admitted wrongdoing.
Schulte, F. (2024, December 20). In settling fraud case, New York Medicare Advantage insurer, CEO will pay up to $100M – KFF Health News. KFF Health News. https://kffhealthnews.org/news/article/medicare-advantage-fraud-lawsuit-settlement-new-york/
Medicare Advantage provider Independent Health to pay up to $98m to settle False Claims Act suit. (2024, December 20). https://www.justice.gov/usao-wdny/pr/medicare-advantage-provider-independent-health-pay-98m-settle-false-claims-act-suit
Wilson, R. (2024, December 23). Medicare Advantage insurer to pay up to $98M to settle false claims allegations. https://www.beckerspayer.com/payer/medicare-advantage-insurer-to-pay-up-to-98m-to-settle-false-claims-allegations.html
Gain clarity on the Medicare Advantage payer rates and contract terms bogging down your team and affecting reimbursements.
