November 29, 2022 @ 1:00 EST

Please join me for a free webinar discussing the “Quiet Part Said Out Loud:” the tension between risk-adjusted health plans, DOJ, OIG, & CMS

There is a heightened tension between the federal government’s current “Regulation by Litigation” paradigm and the reasonable desire of risk-adjusted health plans to be paid based on risk scores that accurately reflect the illness burden of their enrollees. Since 2018, CMS has demonstrated an apparent lack of enforcement discretion related to Medicare-Advantage Risk Adjustment Data Validation Audits (RADV), although it is possible that the agency’s rule making stance may change on or before February 1, 2023. Filling the rule making and policymaking void has been whistle blowers utilizing the False Claims Act, the Department of Justice, and the HHS Office of the Inspector General (OIG). This Regulation by Litigation approach was dramatically strengthened in late 2021 when the DC Circuit Court of Appeals, with the blessing of the Supreme Court, reinstated the Overpayment Rule, requiring health plans that detect overpayments from the government to return the funds within 60 days.

This free webinar will conclude with a proposed solution, involving encounter data that health plans and provider groups can use to determine if they have “crossed the line” by submitting excess diagnosis codes that may be construed by a whistle blower, the DOJ, or the OIG, as inappropriate, or even fraudulent.

Your webinar presenter will be Richard Lieberman, the CEO of Cortex Analytics, Inc. But more importantly, someone who has (for better or worse!), ate, slept, and breathed risk adjustment for the bulk of his adult life! Richard has been working full time in the risk adjustment “world” for 31 years, since joining the risk adjustment development team at the Johns Hopkins Bloomberg School of Public Health in 1991. If it has happened in risk adjustment and/or encounter data, Mr. Lieberman has either done it, seen it, or heard about it!

Please register for the webinar at this link: https://www.eventbrite.com/x/free-webinar-optimizing-risk-score-accuracy-without-crossing-the-line-tickets-461534460997