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Tag Archives: Medicare Advantage

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Medicare Advantage Audit Shows $197 Million in Over-Payments

By McCabe Rabin, P.A. |

In April 2021, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) released a report regarding a Medicare Advantage Compliance Audit of one of the country’s major Medicare Advantage Organizations, Humana, Inc.   The audit covered only one year, 2015, and one particular contract.  The audit selected a random sampling of 200… Read More »

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What is Risk Adjustment Fraud?

By McCabe Rabin, P.A. |

In 1997, Congress decided that traditional Medicare was way too expensive.  At the time, Medicare operated under a traditional fee-for-service model.  Under this model, if a doctor delivered services to Mrs. Jones, the government paid the doctor a fee for his or her services, i.e, fee-for-services. Congress thought it found a better way.  Rather… Read More »

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