Innovaare Compliance

DECEMBER 14, 2023

In recent news, the healthcare industry has been abuzz with significant developments that carry vital lessons for Medicare Advantage plans, particularly in the areas of compliance and risk assessment. CMS’s Role and the RADV Audits Program Medicare Advantage overpayments have become alarmingly problematic in the private payer program.

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Overpayments Overpayment Medicare Medicare 52

YouCompli

MARCH 22, 2023

There has been significant enforcement over the last couple years relating to overpayments for UDT. According to the OIG, prior error rate testing has suggested an improper payment rate of almost 30% for Medicare. The overpayment rate for definitive drug testing for 22 or more drug classes was over 71%.

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Overpayments Overpayment Compliance Medicare 52

Healthcare IT Today

JANUARY 17, 2024

Those are the high-level findings of MDaudit’s 2023 Benchmark Report on the trends, challenges, and opportunities encountered by U.S. The analysis found that there was a fourfold increase in the volume of external payor audits in 2023, further straining healthcare organizations’ already limited resources. healthcare organizations.

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Compliance Overpayments Overpayment Medicare 102

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.

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Overpayments Overpayment Medicare Medicare 40

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. The Final Rule is effective June 5, 2023. Parts 417, 422, 423, 455, and 460. 79452 (2022)). 405.902). Final Rule at p.

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Medicare Medicare Overpayments Overpayment 52

Health Law RX

MARCH 30, 2023

Setting aside the incalculable impact that litigation can have on business operations, the statute itself anticipates repayment of the proven overpayment, treble damages, and exposure to a civil statutory penalty equal to a range between $13,508 and $27,018 per false claim. As for the final judgment award, on March 17, 2023, the U.S.

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Overpayments Overpayment Fraud Governance 52

Innovaare Compliance

MARCH 24, 2024

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 Poor dispute resolution could lead to compliance risks, reputational damage, and even loss of key providers. billion in healthcare fraud judgments and settlements.

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Fraud Health Insurance Compliance Medicaid 52