Healthicity Blog

Medicare Advantage Compliance Under the Spotlight: Lessons from Cigna's $172 Million Settlement

$172 million is a lot of money. It's also the amount that the Cigna Group recently agreed to pay to resolve allegations it violated the False Claims Act in relation to its Medicare Advantage (MA) plan...

The Inspector General of HHS has warned the healthcare compliance community that reimbursement methodologies associated with Medicare Advantage would be a top priority. Included in these efforts is an enhanced focus on Hierarchical Condition Categories (HCC) and risk adjustment.

While the OIG didn’t add a high number of items to its Work Plan in September 2023, the updates it did make are critical.

Patient safety and quality of care has long been a focus area for many providers and health systems.

Enforcement agencies often focus on “following the money.” In other words, big revenue usually is associated with compliance scrutiny – and some of the biggest revenue generators are facilities. This is partially why enforcement agencies, like the U.S. Health and Human Services Office of Inspector...

Let’s delve into the latest Work Plan updates from the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) as we shed light on crucial developments and initiatives shaping the organization's priorities.

Academic medical centers often have unique risks associated with their services.  As a result, their compliance programs need to be designed to account for these risks. 

In November 2022, the U.S. Health and Human Services (HHS) Office of Inspector General (OIG) issued a report titled, “Long-Term Trends of Psychotropic Drug Use in Nursing Homes.”¹ This report highlights areas of weakness related to nursing home patients who may be inappropriately given psychotropic...