Compliance Q&A: False Claims Agreements Signal Regulatory Focus on MA Marketing
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Apr 03, 2025
Of the more than $2.9 billion in recoveries secured last year by the U.S. Dept. of Justice through False Claims Act (FCA) settlements and judgments, more than $1.67 billion involved health care. According to Bass Berry & Sims’ recently released Healthcare Fraud & Abuse Review 2024, the settlements spotlight noncompliance in two highly scrutinized areas of Medicare Advantage: risk adjustment and sales and marketing.
AIS Health, a division of MMIT, spoke with Bass Berry attorney Lindsey Fetzer to understand the implications of these and other cases on MA insurers. Fetzer chairs the firm’s multi-disciplinary Managed Care practice and has extensive experience working with plans, risk-bearing provider groups and vendors in litigation, investigation and compliance counseling matters.
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