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

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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