Adjusting the Risk for Medicare Advantage: Recent Enforcement Trends and Litigation Involving Medicare Advantage Risk Adjustment Practices

Attacks on Medicare Advantage plans’ practices with respect to auditing or reviewing risk adjustment scoring are growing both more complex and popular

While the government has been handed some serious setbacks in the last year, cases involving risk adjustment continue to be brought (both civilly and criminally)

Recent trends in civil and criminal enforcement actions, where courts are lining up on interpreting key regulations, and what all this means for Medicare Advantage providers looking to navigate this high-stakes and ever-changing landscape