Tag Archives: risk adjustment

Lawsuit may indicate change in government’s pursuit of insurance fraud

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: Urban Bohemian via Flickr

Photo: Urban Bohemian via Flickr

A 2011 lawsuit unsealed last week reveals the inner workings of the nation’s largest health insurer, UnitedHealth Group. In the lawsuit, lawyers for the plaintiff allege that UnitedHealth evaluated certain employees on how well they raised risk adjustment scores.

The lawyers contend the practice was part of a scheme to increase payments from the federal Centers for Medicare & Medicaid Services by submitting false statements about the level of illness among Medicare Advantage patients. Continue reading

Health reform: Understanding advanceable tax credit, multi-state plan

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

As implementation of the Affordable Care Act marches on, a host of new terms will become part of health journalists’ new vocabulary.

Core Topics
Health Reform
Aging
Oral Health
Medical Studies
Other Topics

Joanne Kenen, AHCJ’s topic leader on health reform, is steadily adding terms to the health reform glossary and key concepts section of the website to help reporters explain these complicated issues to readers, viewers and listeners.

Two that you’re likely to hear more about are the multi-state plan and the advanceable tax credit. The multi-state plan was devised as a way to add consumer options and competition to the health insurance exchanges [read more] and the advanceable tax credit is what will help lower- and middle-income people buy insurance in the exchanges [read more].

Other terms recently added to the site include:

Be sure to see the data and resource links AHCJ has compiled to help reporters cover this complex topic.