Healthcare Dive

OCTOBER 6, 2023

Medical records provided by the insurer didn’t support certain diagnosis codes, resulting in overpayments, according to an audit from the HHS’ Office of the Inspector General.

Overpayments 328

Overpayments Overpayment 328

Fierce Healthcare

OCTOBER 6, 2023

million in overpayments from Medicare Advantage in 2015 and 2016. | million in overpayments from Medicare Advantage in 2015 and 2016. A new federal audit estimates that Aetna may have received at least $25.5 A new federal audit estimates that Aetna may have received at least $25.5

Overpayments 94

Overpayments Overpayment Medicare Medicare 94

Healthcare Law Today

JANUARY 2, 2023

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.

Overpayments 52

Overpayments Overpayment ACA Medicare 52

Health Law Advisor

FEBRUARY 2, 2023

For these years, CMS will limit payment recoveries to “enrollee-level adjustments,” i.e., the non-extrapolated overpayments identified in CMS RADV audits and Department of Health and Human Services Office of Inspector General (OIG) audits. million from non-extrapolated errors based for PYs 2011–2015, an estimated average of $8.2

Medicare 98

Medicare Medicare Overpayments Overpayment 98

The Health Law Firm

NOVEMBER 21, 2014

A large part of what the OIG does is review and investigate Medicare claims for overpayment. 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.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

Health Care Law Brief

APRIL 3, 2023

The 2024 Risk Model uses diagnoses from 2018 and costs reflected from 2019 as opposed to the 2020 Risk Model that used 2014 diagnoses and 2015 costs. In the Advance Notice, CMS predicted that the changes to the risk scores and HCC updates will help prevent overpayments by improving the accuracy of payments made to MAOs. See 88 Fed.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Healthcare Law Blog

FEBRUARY 9, 2024

In response, ChristianaCare argued that Sherman himself was responsible for reporting any violations of the Anti-Kickback Statue or Stark Law to the OIG and he did not do so, instead certifying compliance with the CIA.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52