health care vendors compile and report risk adjustment data in connection with the Medicare Advantage program, also known as Medicare Part C. The DOJ has intervened in several recent whistleblower cases brought under the False Claims Act,[1] alleging that plans and providers improperly manipulated risk adjustment scores in order to receive higher compensation from the government. We expect this trend to continue in the Biden administration. Risk AdjustmentUnder the Medicare Advantage program, Medicare beneficiaries may enroll in health care plans offered by private insurers. Medicare Advantage plans. . .
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Why it Matters Federal research agencies face mounting pressure to prevent fraud in grant-making, and Congress is moving to hold them accountable. A House subcommittee grant fraud hearing schedule...