What's New

August 4, 2023

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Presbyterian Health Plan, Inc. (Contract H3204) Submitted to CMS A-07-20-01197

First Coast Service Options, Inc., Did Not Claim Some Allowable Medicare Postretirement Benefit Costs A-07-23-00630

First Coast Service Options, Inc., Claimed Some Unallowable Medicare Nonqualified Plan Costs Through Its Incurred Cost Proposals A-07-23-00632

First Coast Service Options, Inc., Overstated Its Medicare Segment Postretirement Benefit Assets as of January 1, 2019 A-07-23-00629

Enforcement Actions

August 3, 2023; U.S. Attorney's Office, Northern District of Ohio

Former Employee Of Eye For Change Youth And Family Services Found Guilty Of Fraudulent Medicaid Billing Practices

August 3, 2023; U.S. Attorney's Office, Central District of California

Former CEO Of Whittier Clinic Pleads Guilty To Defrauding Medi-Cal Family Planning Program Through Multimillion-Dollar Scheme

August 1, 2023; U.S. Attorney's Office, Western District of North Carolina

Former Charlotte Housing Provider Is Sentenced To Prison For Medicaid Fraud And Money Laundering Conspiracy

What's Trending

1. Whistleblower Protection Coordinator
2. High Rates of Prior Authorization Denials by Some Plans and Limited State Oversight Raise Concerns About Access to Care in Medicaid Managed Care
3. Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Excellus Health Plan, Inc. (Contract H3351) Submitted to CMS
4. Adverse Events Toolkits: Medical Record Review Methodology and Clinical Guidance for Identifying Patient Harm
5. Physician Relationships With Vendors