Medicare Compliance

What Cigna’s FCA Settlement Means for Other Medicare Advantage Plans

October 24, 2023 - Cigna’s recent brush with False Claims Act violations serves as a reminder that Medicare Advantage organizations should be routinely assessing their risk and compliance activities. The Department of Justice (DOJ) announced in September that the major payer reached a settlement of $172 million to resolve allegations that it violated the False Claims Act. The United States alleged...


More Articles

OIG Finds CMS Overpaid Geisinger Medicare Advantage Plan by Over $566K

by Kelsey Waddill

The Office of the Inspector General (OIG) found that most of the audited diagnosis codes that Geisinger Health Plan sent to CMS for its Medicare Advantage plan were non-compliant. The office audited...

Inpatient Psych Facilities Spend $1.7B on Medicare Compliance

by Jennifer Bresnick

Inpatient psychiatric facilities are spending a significant proportion of their average revenue on compliance with basic conditions of participation for Medicare, according to a new report from the...

Cigna Re-enters Medicare Advantage Market With CMS Approval

by Jesse Migneault

Cigna announced in a securities filing that it had received the green light from CMS to begin offering Medicare Advantage plans again after an 18 month suspension.  The insurer had been banned...

Senator Calls for Scrutiny of Health Payers, Medicare Fraud

by Jesse Migneault

Senator Chuck Grassley (R-Iowa) is asking federal officials to investigate charges that Medicare Advantage plans were overcharged by health payers. In a letter to CMS Acting...

35 Audits Find Medicare Advantage Plans Overbilling CMS

by Vera Gruessner

Audits conducted by the Government Accountability Office (GAO) reveal that up to 35 Medicare Advantage plans fraudulently billed the federal government for medical care provided to many of its elderly...

New Proposed MACRA Rule Renovates Information Technology Use

by Vera Gruessner

The Department of Health & Human Services (HHS) has proposed new rules regarding the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) which will essentially remove the meaningful use...