August audit heat: False Claims Act settlements put spotlight on upcoding 

Listen to the episode here.

This episode of Off the Record is a bit of a departure: A replay of the Norwood webinar August audit heat: False Claims Act settlements put spotlight on upcoding. 

This was our second largest attended program ever, and the topic so important—recent massive OIG audits in the Medicare Advantage/risk adjustment space resulting in over $550M in financial recoupments—that I wanted to share it with the broadest possible audience. 

The presenter/guest, Norwood SVP of Solutions Jason Jobes, refers to a few slides during the show but does a good job explaining them here. You don’t need visuals…but if you want the slides I’ve provided them on our website. You can find them in a link in the show notes. 

Listen in as we cover: 

• What happened in two big False Claims Act settlements: $541M assessed against The Villages Health, and $14.1M against Complete Health Partners Holdings to resolve allegations of submitting false diagnosis codes/inflated HCCs. 

• That’s not all: More OIG audits in the risk adjustment space 

• How these recoupments impact healthcare providers—not just MA organizations 

• “Mining” for diagnoses vs. appropriate capture 

• Blueprint for staying on the right side of compliance 

• Audit strategy for proactive defense 

References 

• Listen to the podcast here: https://podcasts.apple.com/ph/podcast/august-audit-heat-false-claims-act-settlements-put/id1641739619?i=1000794041723  

• View the slides (free with registration): https://www.norwood.com/resource/august-audit-heat-webinar-slides/  

• View the results and analysis of the live webinar polls: https://www.norwood.com/would-your-organization-stand-up-to-a-targeted-hcc-audit-survey-says-probably-not-we-can-help/