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RISE West 2021

THUR06CPR - Track C (Virtual): Legal Insights Panel: Trends in Audit and Compliance Issues

Sep 2, 2021 2:00pm ‐ Sep 2, 2021 2:45pm


  • Understand the current state of the law in the MA risk adjustment context of how federal courts draw the line between what the U.S. Supreme Court has characterized as “garden-variety breaches of contract or regulatory violations,” which are not actionable under the False Claims Act, and compliance failures that constitute actual fraud
  • Hear points of view on the increasing importance of risk adjustment data validation (“RADV”) audits in today’s Medicare Advantage enforcement landscape
  • Gain insights into the interconnectedness of the government audit process and government litigation process in Medicare Advantage
  • Learn about government enforcement trends in managed care, including the extent to which the Covid-19 pandemic has impacted on-going FCA litigation
  • Analyze recent state and federal cases involving compliance problems, such as the failure of managed care plans to activate compliance software, report unsupported diagnoses, supervise consultants or vendors, audit providers, or “look both ways” when conducting chart reviews


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