Nelson Mullins partners Brook Andrews and John Claud authored an article in the August 2026 issue of Compliance Today examining the compliance implications of Aetna’s $117.7 million False Claims Act settlement involving Medicare Advantage risk-adjustment practices.

In “Aetna’s $117.7-Million Lesson for MA Plans and Part D Sponsors,” Andrews and Claud analyze the government’s allegations that Aetna failed to correct unsupported diagnoses identified through chart reviews and submitted morbid-obesity diagnosis codes that were inconsistent with patients’ medical records. The authors explain how the settlement highlights “reverse false claim” exposure when organizations identify potential overpayments but do not take appropriate corrective action.

The article also explores how expanded Medicare coverage for GLP-1 medications could increase scrutiny of obesity-related diagnosis data. Andrews and Claud recommend that Medicare Advantage plans and Part D sponsors audit the source and clinical support for obesity diagnoses, document corrective actions, address unfavorable review findings as rigorously as favorable ones, and maintain effective internal reporting channels.

Click here to read the article.