article thumbnail

Will CMS’s Proposed Rule on “Identified Overpayments” Increase Reverse FCA Cases?

Healthcare Law Today

As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. And, a provider is required to refund overpayments it is obliged to refund within 60 days of such identified overpayment.

article thumbnail

CMS’s Final Rule on Medicare Advantage Risk Adjustment Data Validation

Health Law Advisor

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. billion between 2023 and 2032 from MAOs based on both non-extrapolated and extrapolated overpayment amounts.

Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

article thumbnail

Office of Inspector General Work Plan 2015: A Provider's Overview-Part 1

The Health Law Firm

This Work Plan is the general overview of how the OIG intends to carry out its mission to make the Medicare and Medicaid programs run more smoothly and efficiently in the following year. A large part of what the OIG does is review and investigate Medicare claims for overpayment.

article thumbnail

Medicare Advantage 2024 Rate Announcement – Further Impacts to Risk Adjustment

Health Care Law Brief

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). See Report to Congress: Risk Adjustment in Medicare Advantage (Dec. See 88 Fed. 6643 (Feb.

article thumbnail

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010

CMS.gov

Administrator, Centers for Medicare & Medicaid Services. One of my commitments as the Administrator of the Centers for Medicare & Medicaid Services (CMS) is to ensure we remain steadfast in our commitment to strengthen Medicare by making sure that tax dollars are spent appropriately. percent in 2015 to 17.61 Leadership.

article thumbnail

Home Health PPS Proposed Rule for CY2023: More Bad News for the Home Health Industry

Hall Render

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CMS states a temporary adjustment is necessary to offset this overpayment. Submission of All-Payer OASIS Data.