Federal scrutiny of Medicare Advantage continues to intensify, with recent False Claims Act settlements placing increased attention on risk adjustment practices. A recent RISE article examines three questions expected to shape Medicare Advantage fraud litigation: which allegations are likely to survive the pleading stage, when failing to delete unsupported diagnosis codes may create liability, and whether enforcement could expand into Star Ratings.
Jason Silberberg addressed the potential for Star Ratings to become the next area of government scrutiny. Given the importance of Star Ratings to Medicare Advantage organizations and the significant federal payments tied to the program, Jason explained that regulators may increasingly examine whether Star Ratings metrics have been improperly reported or manipulated.
“Stars metrics fraud seems like a natural next target for future OIG and DOJ investigations.”
Jason will speak at RISE West 2026 during the session, “RA Litigation Today: What Lawyers Say About Risk, Enforcement, and Exposure,” on Thursday, September 3, 2026. The session will examine recent False Claims Act cases, Department of Justice enforcement priorities, OIG audit trends, and the potential expansion of enforcement into Star Ratings.
