The Justice Department sued Anthem in March 2020, alleging the insurer's risk adjustment practices led to more than $100 million in Medicare Advantage overpayments and violated the False Claims Act.  

Providers, nursing home representatives, and advocates for residents say Medicare Advantage plans are increasingly ending members’ coverage for nursing home and rehab services before patients are healthy enough to go home.

Patients who are ready to be discharged to other facilities are forced to stay in inpatient beds, costing health systems money.

To strengthen quality efforts, health systems are using data and external frameworks to identify organizational areas for improvement.