Study reveals Medicare Advantage risk score inflation; OIG updates exclusions list;

News From Around the Web

> A federal study revealed that many Medicare Advantage plans inflate patient risk scores and that the problem may worsen unless the government cracks down on the practice, ProPublica reported. Article

> The Office of Inspector General updated its list of excluded individuals and entities with July, 2014 exclusions and reinstatements, creating a complete database file of all exclusions now in effect. List

> A disbarred Florida attorney was sentenced to prison for her role in $28.3 million Medicare fraud scheme involving physical therapy clinics, according to the Department of Justice. Announcement

Pharma News

> Pfizer has cleared the decks of a marketing scandal that it inherited with its 2009 acquisition of Wyeth. The New York drug maker will pay $35 million to 41 states and the District of Columbia to settle a case of pushing it of pushing a kidney transplant drug for off-label uses. Article

> U.S. legislators are threatening to make it more difficult for American companies to take off for a new home in a tax-advantaged country. But what's in store for drug makers who have already wrapped their own so-called tax inversion deals--and those who are planning them for the future? Article

Payer News

> Legal challenges are giving states and their governors more power to run healthcare insurance coverage programs, an unintended result of the healthcare reform. Article

> As more insurers release their 2015 premium requests, some hope to gain a larger share of their market by dropping their rates. Article

> With the Affordable Care Act providing broader access to insurance, states and insurers are both working to prevent new health plan members from coverage disruptions when they transition between different plan types. Article

And finally … You've just been indicted for fraud! What are you going to do next? Article

Suggested Articles

The HHS OIG is asking for an additional $23.7 million to support fraud oversight that has benefited from an emphasis on data analytics.

A New York surgeon was sentenced to 13 years in prison for fraud and more physician practice news from around the web.

A federal judge has ruled that the U.S. government’s remaining fraud case against UnitedHealth can move forward.