JD Supra

FCA Settlement Highlights DOJ’s Focus On Medicare Advantage Coding Practices

On August 26, 2026, the United States Department of Justice (DOJ) announced a USD541.5 million False Claims Act (FCA) settlement with The ...
JD Supra

DOJ Touts Settlement Agreement with Healthcare Provider Group for $541.5 Million to Resolve False Claims Act Allegations Related to Medicare Advantage Diagnosis Coding

On August 26, 2026, the Department of Justice (DOJ) announced that The Villages Health System, LLC (TVH), a healthcare provider group located ...

For 4 Years, The Villages’ Top Health Provider Allegedly Filed False Medicare Codes. The Bill Just Came Due: $541.5 Million.

A retirement community's top health provider quietly told the government it had been overbilling Medicare for years, then ...
Hosted on MSN

Learn About Insurance Codes to Avoid Billing Errors

Understanding codes on medical bills can help avoid billing mistakes. Healthcare providers use CPT, HCPCS, and ICD codes for services and diagnoses. Wrong codes can lead to unpaid claims or higher ...
Health Affairs

In-Home Health Risk Assessments And Chart Reviews Contribute To Coding Intensity In Medicare Advantage

There is widespread agreement that taxpayers pay more when Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans than if those beneficiaries were enrolled in traditional Medicare. MA ...
McKnight's Long-Term Care News

Ask the payment expert: How should we appropriately query the physician to support diagnosis coding for PDPM reimbursement?

Q: How should we appropriately query the physician to support diagnosis coding for PDPM reimbursement? A:With only a few exceptions, ICD-10-CM code assignment must be based on documentation by the ...