Risk Adjustment Programs Are Under Fire

Over the past year, there has been a noticeable uptick of claims against Medicare Advantage Organizations centering around what the government states are aggressive initiatives allegedly focused on boosting risk scores.

In reality, this is a story of two sides of the same coin — compliance.

Now is the time for MAOs to review and tighten their risk adjustment processes to strengthen their compliance in an effort to minimize the likelihood of enforcement actions and high-cost lawsuits.

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