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Aetna may have received $25.5M in MA overpayments for 2015 and 2016, audit finds

Healthcare Dive

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.

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Medicare Advantage overpayments could exceed $75B this year, study finds

Healthcare Dive

The figure is almost triple prior estimates of MA overpayments, highlighting the need for payment reform to avoid overtaxing the Medicare system, researchers said.

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SCOTUS rejects UnitedHealth appeal of Medicare Advantage overpayment rule

Healthcare Dive

The justices declined to take up the case, leaving intact a lower court ruling that backed the 2014 CMS regulation requiring swift return of overpayments.

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CMS Proposes to Amend Overpayment Rule, Remove Potential Overpayment and False Claims Act Liability for Mere Negligence

Healthcare Law Blog

The Centers for Medicare and Medicaid Services (“CMS”) has issued a proposed rule which would amend the existing regulations for reporting and returning identified overpayments (the “Proposed Rule”). UnitedHealthcare challenged the current Overpayment Rule in litigation. [1] UnitedHealthcare Litigation. The Proposed Rule.

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OIG audit: Aetna may have raked in $25.5M in MA overpayments in 2015, 2016

Fierce Healthcare

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

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Medicare Advantage overpayments continue to balloon. Here are ways policymakers could address the problem

Fierce Healthcare

Steve Lieberman and other experts co-authored | While insurers would likely fight massive changes to the program, experts say less drastic updates could still go a long way toward lowering overpayments. When Paul Ginsburg, Ph.D.,

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Medicare Advantage Overpayments: Are You Ready for RADV Audits?

Innovaare Compliance

CMS’s Role and the RADV Audits Program Medicare Advantage overpayments have become alarmingly problematic in the private payer program. The USC Schaeffer Center for Health Policy & Economics estimated that Medicare Advantage overpayments may exceed $75 billion in 2023. appeared first on Inovaare.