- Posts by Chloe T. Hillard
AssociateChloe Hillard helps health care organizations develop the legal solutions they need in today’s health care space.
Chloe assists hospitals, physician practices, and other health care providers with a broad range of legal ...
In an indictment announced on October 26, 2023 in Miami, the U.S. Department of Justice, Criminal Division’s Fraud Section, working with the FBI and HHS-OIG, brought what may be only the second federal criminal charges directly related to the Medicare Advantage (Medicare Part C) risk adjustment payment methodology. DOJ enforcement in the Medicare Advantage risk adjustment space overwhelmingly has proceeded civilly under the False Claims Act. Although the allegations suggest conduct far more troubling than prior civil cases under risk adjustment, these criminal charges ...
On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The final rule codifies long-awaited regulations first proposed by CMS in 2018.
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Recent Updates
- CMS Attempts to Use Medicare and Medicaid Conditions of Participation to Ban Hospitals from Providing Gender-Affirming Care to Minors
- Eleventh Circuit Hears Arguments in Case Addressing Constitutionality of False Claims Act’s Qui Tam Provisions
- First Circuit Clarifies When Clinical Labs Can Rely on Physician Orders
- Understanding the False Claims Act Statute of Limitations—and the Debate Over the “Last Overt Act” Rule
- Podcast: The Down-Low on Data for Value-Based Enterprises and Their Participating Providers – Diagnosing Health Care