Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. billion in overpayments from MAOs for payment years 2011 through 2017. Further, CMS estimates that beginning with payment year 2018, it will identify approximately $479 million per audit year in overpayments to MAOs.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. CMS also stated in the final rule that it will not apply a Fee-For-Service (FFS) Adjuster in its RADV audits.

Medicare 98

Medicare Medicare Overpayments Overpayment 98

Healthcare Compliance Blog

MARCH 16, 2022

In a March 11, 2022, release by the Northern District of Georgia’s Office of the Department of Justice, it was reported that an investigation determined a Georgia nursing home knowingly submitted claims for unreasonable, unnecessary, and unskilled services for Medicare patients. This amount was based on the nursing home’s ability to pay.

Nursing Homes 59

Nursing Homes Nurses Overpayments Overpayment 59

Healthcare Law Blog

FEBRUARY 1, 2023

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). CMS will not apply a Fee-For-Service (“FFS”) Adjuster in RADV audits. Becerra et al.,

Medicare 105

Medicare Medicare Overpayments Overpayment 105

Healthcare Law Blog

SEPTEMBER 28, 2023

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. Challenge in Court On September 1, 2023, Humana Inc. and its subsidiary Humana Benefit Plan of Texas, Inc.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Kaiser Health News

JUNE 29, 2022

They cited a slew of critical audits and other reports that described plans denying access to health care, particularly those with high rates of patients who were disenrolled in their last year of life while likely in poor health and in need of more services. Diana DeGette (D-Colo.),

Medicare 105

Medicare Medicare Governance Overpayments 105