Executive Briefing | March 1, 2017

The Siege Continues: Justice Department Investigating Four Additional Medicare Advantage Plans

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WHO IS AT RISK The federal government has indicated that it is still investigating, and could ultimately join a false claims whistleblower qui tam action against Aetna, Inc., Humana, Inc., Cigna, Inc. (through its Bravo Health unit) and Health Net,…

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Executive Briefing | February 20, 2017

Medicare Advantage Plans Under Siege: Another Whistleblower Lawsuit

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In a court decision last year in Swoben v. United Healthcare, the United States Court of Appeals for the Ninth Circuit held that an allegation—that a Medicare Advantage Plan performed a “biased” HCC-RAF retrospective medical review designed only to identify…

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Whitepaper | January 27, 2016

It Takes Three to Tango: Structural Collaboration Between Carriers, Providers and Consumers

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The adoption of a comprehensive collaboration model between consumers, providers and carriers will bring opportunity to an industry in search of a sustainable solution. Key to the success of this collaboration is a model that incorporates both a consumer-oriented product…

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