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Risk Adjustment: Why "Actuarial Equivalence" Matters for Medicare Advantage Organizations


AHLA Educational Call

September 14, 2017

In an American Health Lawyers Association call, Melissa Hulke discussed background on risk adjustment within Medicare Advantage; the requirement of "Actuarial Equivalence" within the Medicare Act, the 2014 CMS Overpayment Rule, and implications for MAOs; increased enforcement efforts, including False Claims Act liability, for risk adjustment overpayments; and health plans as plaintiffs-affirmative litigation challenging the Overpayment Rule, including description of the claims, preliminary rulings, and chances of success.

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