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Federal Reports
Report Date
Agency Reviewed / Investigated
Report Title
Type
Location
Department of Justice
Investigative Summary: Findings of Misconduct by an FBI Special Agent in Charge and Assistant Special Agent in Charge for Failing to Ensure Contact with a Known Drug Trafficker was Handled According to FBI Policy for Confidential Human Sources, and for Fa
Under the Medicare Advantage (MA) program, the Centers for Medicare & Medicaid Services (CMS) makes predetermined monthly payments to MA organizations according to a system of risk adjustment that depends on the health status of each enrollee. Accordingly, MA organizations are paid more for providing benefits to sicker enrollees than to healthier enrollees. To determine the health status of enrollees, CMS relies on MA organizations to collect diagnosis codes from their providers and submit these codes to CMS. Some diagnoses are at higher risk for being miscoded, which may result in overpayments from CMS.