The DOJ’s recent complaint-in-intervention in US ex rel. Poehling v. United Health Group—one of two qui tam cases against United Health currently pending in the Central District of California—emphasizes the government’s view that, in order to avoid FCA liability based on allegedly inflated risk adjustment scores for Medicare Advantage members, health plans must follow up on any information they know or have reason to know indicating that providers are submitting or have submitted invalid codes to the health plan.
Continue Reading Second DOJ Complaint: Knowledge of Invalid Codes Requires Follow-Through to Avoid Liability