The federal government’s Medicare Advantage enforcement campaign has shifted decisively toward targeting healthcare providers, highlighted by the Department of Justice’s recent $541.5 million settlement with The Villages Health System and a series of other high‑profile actions. Providers now face heightened scrutiny of how their coding practices, financial incentives, and vendor relationships may contribute to significant False Claims Act exposure.
The webinar examines critical developments for providers who contract with and submit claims to Medicare Advantage plans, including the evolving enforcement landscape, the growing role of AI in compliance and government oversight, intensified scrutiny of risk adjustment diagnosis coding and its implications for providers, key considerations for MA contract negotiations, and important factors for providers entering marketing arrangements with MA plans. We will also outline practical steps providers can take to minimize risk in this rapidly shifting environment.