Value-based care
A reckoning for Medicare Advantage: Inside the Kaiser case with Mary Inman and Liz Soltan
Listen to the episode here. Medicare Advantage is undergoing a reckoning … and that reckoning is coming from within. In January Kaiser Permanente affiliates agreed to pay $556 million to resolve allegations that it violated the False Claims Act by submitting invalid diagnosis codes for their MA Plan enrollees in order to receive higher payments…
Read MoreA very bad start to the year for Medicare Advantage; whistleblowers and government officials expose questionable risk adjustment coding practices
By Brian Murphy This has been a terrible start to the year for Medicare Advantage. Senator Chuck Grassley’s report “How UnitedHealth Group Puts the Risk in Medicare Advantage Risk Adjustment” landed like a bombshell on Jan. 12. It revealed the extent of UHG’s “robust diagnosis capture workforce,” from advanced analytics to in-home health assessments…
Read MoreDownload The State of Value-Based Care, our latest white paper.
We’re kicking off 2026 with a special report on The State of Value-Based Care. This paper shows where we are nationally with CMS’ stated goal of Every Traditional Medicare beneficiary in an accountable care relationship by 2030. It also offers critical tips and strategy on compliant risk adjustment, depiction of patient illness, and compliance with…
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