The needs-based and at the same time legally permissible application of the employee concept is of material practical relevance: If an individual is to be classified as an employee within the meaning of Section 2 (7) IVV in relation to their professional activity for the institution, the remuneration that they receive for this professional activity from the institution or from a third party is generally subject to the regulatory requirements of the IVV and the German Banking Act (Kreditwesengesetz, KWG, Section 2 (1) IVV). This applies in particular to any variable remuneration received in relation to the professional activity for the institution, which, among other things, (1) in relation to the fixed remuneration, is subject to the upper limit of a maximum of 100% (/200% if the shareholders of the institution so decide) (Section 25a (5) KWG), (2) be compatible with the institution's business and risk strategy in terms of content (Section 4 IVV), and (3) take into account any negative performance contributions in their final determination (Section 5 (2) IVV). If the specific person qualified as an employee within the meaning of Section 2 (7) of the IVV is identified as a Material Risk Taker (Section 25a (5b) KWG) in a significant institution (Section 1 (3c) KWG) or in a qualified, non-significant institution (Section 1 (3) sentence 2 IVV), the variable remuneration is also subject to the special requirements of Sections 18 et seq. IVV.
Key Takeaways Aetna allegedly leveraged inaccurate Medicare Advantage diagnosis coding to elevate risk adjustment payments, including morbid obesity coding inconsistent with clinical documentatio...