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Medicare Advantage Overpayments: Are You Ready for RADV Audits?

Innovaare Compliance

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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Healthcare Compliance Risks with Urine Drug Testing Overpayments 

YouCompli

There has been significant enforcement over the last couple years relating to overpayments for UDT. The overpayment rate for definitive drug testing for 22 or more drug classes was over 71%. Review at-risk payments made to at-risk providers during and after the OIG’s audit period and recover any overpayments.

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Understanding Basics of Medicare Overpayment

Medisys Compliance

What is Medicare Overpayment? An overpayment is a payment made to a provider exceeding amounts due and payable according to existing laws and regulations. Identified overpayments are debts owed to the federal government. Laws and regulations require CMS recover overpayments. Medicare Overpayment Collection Process.

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The Final Rule: How to Prevent $389,000 in Medicare Overpayments

Healthicity

In a recent audit of a New York hospital, the HHS OIG identified overpayments. New York Hospital to Pay $389,000 to Medicare.

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Department of Justice (DOJ) Evaluation of Corporate Compliance Programs

Compliancy Group

Regarding compliance in the healthcare field, a practice, doctor’s office, or healthcare organization is constantly in the spotlight. A Department of Justice (DOJ) evaluation of a corporate compliance program involves an examination of its effectiveness in preventing and detecting instances of noncompliance.

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The Supreme Court Denies Petition Challenging CMS’s Overpayment Rule

Health Care Law Brief

With this denial, the Overpayment Rule remains in full force and effect, and UnitedHealthcare, among other MA plans, must comply or potentially face False Claims Act (FCA) liability. The Overpayment Rule. The Overpayment Rule, set forth at 42 U.S.C. 29844, 29921 (May 23, 2014). See UnitedHealthcare Insurance Co. 3d 173 (Sep.

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New York State OMIG Makes Regulatory Modifications to Compliance Program Requirements

Health Law Advisor

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. These regulations were proposed to implement portions of the New York State 2020-2021 Budget Bill amending the mandatory compliance program requirements. New York Social Services Law § 363-d.