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Ropes & Gray LLP

CMS Announces Significant Changes to RADV Auditing Efforts: Considerations and Next Steps for the Medicare Advantage Industry

Ropes & Gray LLP on

On May 21, 2025, the Centers for Medicare and Medicaid Services (“CMS”) announced plans to substantially increase both the pace and the scale of Risk Adjustment Data Validation (“RADV”) audits of the Medicare Advantage (“MA”)...more

Morgan Lewis - Health Law Scan

Mass. USAO Focuses on Healthcare Fraud in Private Equity Investments, Broker Arrangements at Annual Conference

On May 8, 2025, the Boston Bar Association hosted its annual White Collar Crime Conference, a reoccurring theme of which was the recognition of changing times, while also maintaining that the core principles of criminal and...more

Holland & Knight LLP

Holland & Knight Health Dose: May 6, 2025

Holland & Knight LLP on

Reconciliation markups in the U.S. House of Representatives Committee on Energy and Commerce, as well as the House Committee on Ways and Means, were expected to be held this week but have been postponed until next week at the...more

Morgan Lewis

Risk Adjustment Continues to be A Major Focus in Medicare Advantage

Morgan Lewis on

Medicare Advantage is the dominant Medicare delivery system, now covering 54% of all Medicare enrollees. With the increase in enrollment and federal spending, however, has come increased scrutiny from enforcement and...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

The Medicare Advantage Program: Public Money & Private Insurance Companies

When I investigated and litigated False Claims Act (FCA) cases at the U.S. Department of Justice (DOJ) over the last 10 years, I was often surprised by just how little I knew about the broad array of government agencies and...more

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