HHS OIG Audit Report on Institutional Status of Medicare + Choice Enrollees
Client Alert | 1 min read | 04.12.03
The HHS Office of Inspector General has released an April 11, 2003 audit report on Medicare + Choice plan institutional status classifications of Medicare + Choice enrollees. Institutional status results in a higher monthly capitation to the plan. The OIG report faults the audited plan for assigning institutional status to patients who were in Medicare certified facilities, but not occupying a bed in a distinct Medicare certified portion of the facility. The OIG audit report rejects Coventry's argument that CMS instructions and the applicable CMS policy letter require only that the beneficiary reside in a certified facility, and not that the bed itself be in beds that the facility has allocated or identified as within a certified portion of the facility. The OIG auditors' position appears contrary to informal guidance previously provided by CMS to health plans. Here is a link to the audit report. http://oig.hhs.gov/oas/reports/region7/70200148.htm
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Client Alert | 3 min read | 11.21.25
On November 7, 2025, in Thornton v. National Academy of Sciences, No. 25-cv-2155, 2025 WL 3123732 (D.D.C. Nov. 7, 2025), the District Court for the District of Columbia dismissed a False Claims Act (FCA) retaliation complaint on the basis that the plaintiff’s allegations that he was fired after blowing the whistle on purported illegally discriminatory use of federal funding was not sufficient to support his FCA claim. This case appears to be one of the first filed, and subsequently dismissed, following Deputy Attorney General Todd Blanche’s announcement of the creation of the Civil Rights Fraud Initiative on May 19, 2025, which “strongly encourages” private individuals to file lawsuits under the FCA relating to purportedly discriminatory and illegal use of federal funding for diversity, equity, and inclusion (DEI) initiatives in violation of Executive Order 14173, Ending Illegal Discrimination and Restoring Merit-Based Opportunity (Jan. 21, 2025). In this case, the court dismissed the FCA retaliation claim and rejected the argument that an organization could violate the FCA merely by “engaging in discriminatory conduct while conducting a federally funded study.” The analysis in Thornton could be a sign of how forthcoming arguments of retaliation based on reporting allegedly fraudulent DEI activity will be analyzed in the future.
Client Alert | 3 min read | 11.20.25
Client Alert | 3 min read | 11.20.25
Client Alert | 6 min read | 11.19.25
