Finance Director for UnitedHealth Group brought qui tam suit against UnitedHealth Group, Inc. alleging that the organization upcoded risk adjustment data resulting in increased payments (more than $1.14 billion) to UnitedHealth Group. The Department of Justice (DOJ) intervened in the case, yet UnitedHealth Group was successful in getting the primary False Claims Act Claims dismissed by arguing that the Centers for Medicare & Medicaid Services (CMS) would not have refused to make the adjustment payments had they known of the errors in the risk adjustment. The Escobar materiality standard helps clarify threshold level of risk to Managed Care Providers in attesting to their risk adjustment payments; the falsities must have had an impact on the respective payment.
During his first 67 days in office, Mr. Trump signed 19 executive orders. One such action designed to roll back regulations from the 2010 Dodd-Frank Act (“Act”) received little to no media attention but may have long lasting ramifications in the financial industry.
Mac Matarieh Associate Editor Loyola University Chicago School of Law, JD 2018 Inside of President-Elect Donald Trump’s 100 Day Action Plan is a requirement that for every new federal regulation, two existing regulations would be eliminated. Mr. Trump has consistently pushed the narrative of an outright repeal of the Affordable Care Act. Further, Mr. …