Events
AHLA Institute on Medicare and Medicaid Payment Issues
Partner Jolie Apicella will speak at the Institute on Medicare and Medicaid Payment Issues Conference for the “Medicare Advantage Fraud Enforcement Under a New Administration: Mitigating Risk for Criminal and Civil Actions” panel for two sessions.
She will present an overview of Medicare Advantage fraud enforcement under the new administration and outline strategies to reduce the risk of criminal and civil exposure.
Topics include:
- An examination of the administration’s priorities related to Medicare Advantage fraud, how these initiatives align with broader agency enforcement goals, and the resulting impact on providers.
- A review of recent DOJ activities in this space viewed alongside current civil enforcement trends.
- An analysis of the most recent HHS‑OIG Semiannual Report to Congress. The June 2025 report released under the Trump Administration emphasized continued attention to healthcare fraud and described Medicare Advantage as an area with a high risk of fraud, waste, and abuse. By the time of this program, a new report will be available and we will compare its treatment of Medicare Advantage risk adjustment to determine whether the program remains identified as a high‑risk area.
- A review of significant settlements, lawsuits, and enforcement actions over the past year following matters involving HealthSun, Poehling, Anthem, Kaiser, and other organizations.
- Practical guidance and best practices for healthcare organizations participating in Medicare Advantage to maintain compliance and reduce risk in an environment of heightened scrutiny.
