Topic
Medicare Advantage
305 published works
The Healthcare Investor
Where Value-Based Care Actually Works, With Dawn Owens
https://player.captivate.fm/episode/792a9c38-7378-4821-905b-73d0c03184e3 Value-based care is one of healthcare's biggest bets on changing how care is delivered and paid for, but how well has it worked? Dawn Owens, CEO and partner at…
Thompson Coburn LLP
Mackenzie Wallace, Ashton Dietrich Examine Payer Pressures Facing Rural Hospitals
In a recent Chief Healthcare Executive article, Thompson Coburn Health Care attorneys Mackenzie Wallace and Ashton Dietrich examined the growing pressures rural hospitals face when negotiating with Medicare Advantage and commercial payers. The article outlines key…
Original Source
DOJ Continues to Prioritize Medicare Advantage Enforcement with $22.5 Million Settlement
By Jaime L.M. Jones, Matt Bergs, Lauren E. McBride
On September 30, 2026, the Department of Justice announced a $22.5 million settlement with a Medicare Advantage (“MA”) plan to resolve allegations that it violated the False Claims Act by…
Whistleblower Law Collaborative Blog and News
Medicare Part C Fraud Enforcement Hits New Highs
At the beginning of 2026, we predicted that Medicare Part C Fraud would remain one of the leading areas of False Claims Act enforcement this year. Nine months and nearly…
Triage Health Law
What Medicare Advantage Organizations Need to Know About OIG’s 2026 Compliance Guidance
In February 2026, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released new Industry Segment-Specific Compliance Program Guidance (Guidance) for Medicare Advantage Organizations (MAOs). While…
Inside the False Claims Act
The Villages Health System Settles Medicare Advantage Risk-Adjustment Allegations for $541.5 Million
By Lindsey Fetzer, Ellen Pasquale
On August 26, the Department of Justice (DOJ) announced that The Villages Health System, LLC (TVH), a healthcare provider group located within The Villages retirement community in central Florida, agreed…
Original Source
$14.1 Million FCA Settlement Underscores Medicare Advantage Coding Scrutiny
By Jaime L.M. Jones, Matt Bergs, Anna M. Schmitt
On August 3, 2026, DOJ announced a $14.1 million settlement with a management services organization (“MSO”) for primary care groups to resolve allegations that the organization violated the False Claims…
Medicaid & Medicare: A Legal Blog
Pay Me What You Owe Me!: Why Medicare Providers Should Stop Waiting and Start Litigating
Under 42 C.F.R. § 422.214(a)(1), a noncontract provider that furnishes services to an MA enrollee must accept as payment in full: “the amounts that the provider could collect if the beneficiary…
Jotwell
Preemption in a Deregulatory Era
By Zack Buck
In Do Nothing Preemption, Professor Lauren Roth takes on the legal thicket of preemption—the all-too-familiar hornet’s nest within the federalism-dominated landscape of health law. Roth’s project is particularly timely. Considering…
Medicaid & Medicare: A Legal Blog
Medicare Advantage Plans Overturned Nearly All Appealed Skilled Nursing Facility Denials, OIG Finds!
Does your facility appeal recipient admission denials? Want to increase revenue and help consumers receive medically necessary health care services? Appeal consumer admission denials. A new report from the U.S.…