Medicare Advantage Fraud Investigations Could Affect Insurance Models

DOJ’s Medicare Advantage Lawsuits, Investigations Likely to Change Insurance Culture
– Modern Healthcare
Modern Healthcare interviewed Manatt’s Michael Kolber, a partner with Manatt Health, for an article on how insurers are likely to change the way they do business as the DOJ increases its focus on investigating alleged fraud in the Medicare Advantage program.
The publication reports that under the current fee-for-service model, some doctors weren't dedicated to documenting every condition because that didn't affect how they were paid, especially in outpatient settings.
"In the traditional fee-for-service world, doctors were getting paid on what procedures they did," said Kolber. "The plans had an incentive to be vigilant on upcoding and fraud and abuse from providers."

Read the article here



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