Medicare Advantage Risk Adjustment and Its Effect on MSOs
Medicare Advantage (MA) plan enrollment and costs have exploded over the past two decades. In 2021, more than 26 million people enrolled in MA, accounting for approximately 42 percent of the total Medicare-eligible population and $343 billion (or 46%) of total federal Medicare spending. With increasing enrollment and spending comes a greater risk of fraud as well as heightened scrutiny from regulatory agencies and whistleblowers.
The DOJ, HHS-OIG, CMS, and others are working together to identify and prosecute fraud in the MA space. Understanding risk areas and steps to minimize exposure based on enforcement trends is a must have for MA plans, MSOs, providers, and those who invest in them. This presentation will discuss:
- Enforcement trends in Medicare and Medicaid Managed Care
- Key risk areas and best practices to minimize exposure
- The dangers of compliance deficiencies in risk adjustment data and program processes
Co-Founder & Partner
Co-Founder & Partner
Assessing Regulatory Risk When Making Healthcare Acquisitions
Federal enforcement action is one of the fastest ways that an otherwise profitable investment can go sour. A critical component of any healthcare acquisition is an assessment of the risk of adverse government action. Even small errors in that assessment can radically change the viability of a proposed deal.
In this interactive presentation, attorneys from Elliott Sauter will provide insight into some of the components of regulatory risk assessment: Structural analysis, evaluation of physician compensation, and the importance (and pitfalls) of fair market value analysis.
In addition to discussing these general principles, this expert panel will address several breaking trends in federal enforcement including the following:
- The government’s increasing interest in the internal operations of private equity funds
- Identifying the fine line between legitimate and criminal telemedicine arrangements in a post-Covid world
- Understanding the rise (and potential fall) of healthcare “tech” companies
Chief Executive Officer
Senior Vice President
& Chief Risk Officer
Under Attack: Cybersecurity and HIPAA Compliance Challenges Facing MSOs
As physician practices grow in size and complexity under management services organization (MSO) structures, their threat surfaces grow, and their vulnerabilities increase. As such, the likelihood and the harm of a cyberattack increase. A ransomware attack or breach not only impacts patient care but can also devastate the organization’s reputation and destroy long-term shareholder equity value.
With cyberattacks expected to triple in 2021, physician practice management groups (PPMGs) face an enormous business risk this year. Making the right investments in IT security could prove crucial to your ability to attract and retain patients and achieve your growth targets.