Risk Adjustment fraud is a major problem estimated to cost Medicare billions of dollars per year. Here is how it works. Medicare pays Medicare Advantage plans a “capitated” rate per insured. That is, they pay a flat rate per covered person per month. However, to compensate plans for the fact that some insureds are at […]
Really Disturbing FCA Case From Los Angeles
Last week the DOJ intervened in a case alleging that federally funded housing developments in Los Angeles were falsely certifying compliance with federal accessibility laws in connection with claims submitted to HUD for millions of dollars in housing grants. According to the DOJ: [T]hese laws require that five percent of all units in certain federally-assisted […]