Health Payer Specialist Quotes Paul Werner on False Claims Act Working Group

Buttaci, Leardi & Werner member Paul Werner was quoted in an article in Health Payer Specialist titled “Will the New Joint HHS-DOJ Task Force Herald a New Era of Scrutiny for Medicare Advantage Payers?” The article, published July 28, discusses the False Claims Act Working Group, a joint task force set up by the Departments of Justice and Health and Human Services aimed at rooting out fraud in the healthcare system.

The article questions, in particular, what the new working group might mean for Medicare Advantage insurers and their use of adjustment and coding practices – which have undergone a fair amount of scrutiny in recent times.

“My impression is that the Working Group is more for show than anything else,” says Werner. “DOJ has put increased emphasis on FCA enforcement in the healthcare industry year over year without fail, and this is just another example of that.”

The article notes that a general consensus among legal experts is that the task force will focus on Medicare Advantage payers’ use of risk score inflation, unsupported diagnoses, and upcoding.

“Upcoding can be difficult to prove in the litigation context because it lends itself to a battle of the experts, which is generally not a place the government wants to be,” Werner adds. The full article can be read at Health Payer Specialist, a specialty publication of the Financial Times (subscription required).

• Posted on: Sep 3 2025