Risk Adjustment Whistleblower Ross Recalls Exclusion, Isolation, Gaslighting
-
Mar 20, 2025
As Medicare Advantage insurers seek ways to maximize revenue in a fiscally challenging environment, the accurate and complete capture of diagnosis codes is paramount. That’s because their reimbursement is dependent on the documented health of their enrollees and related risk scores. But risk adjustment comes with inherent compliance risks, demonstrated by pending lawsuits involving the use of chart review and addenda programs and a recent settlement involving whistleblower Teresa Ross, a former MA plan employee who spoke at the 2025 RISE National conference.
“It’s a very isolating and lonely time. The whole time the company is gaslighting you. You say too much, so then you get excluded from meetings,” said Ross. At one point, her employer sent a mental health counselor to her office “to try to tell me that I was wrong for not going along,” she recalled.
Read more
© 2024 MMIT
Related Posts
-
![]()
Mar 06
UnitedHealth Notches ‘Symbolic Win’ for Medicare Advantage Industry on Chart Reviews
Read more -
![]()
Feb 20
New Studies on Medicare Advantage Coding Intensity Seek to Level the Playing Field
Read more -
![]()
Jan 16
Trump 2.0 Faces Lingering Legal Questions Regarding RADV Audits, Stars, Broker Pay
Read more
The Latest
Meet Our Reporters
Meet Our Reporters
GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND
Sign up for publications to get unmatched business intelligence delivered to your inbox.