“The Centers for Medicare & Medicaid Services is ready to charge ahead with broad audits of Medicare Advantage plans, which could result in companies paying back billions of taxpayers dollars to the federal government…”
“… How it works: The federal government pays Medicare Advantage companies monthly amounts based on how sick their enrollees are. Insurers code the conditions people have, and the more health problems someone has, the more insurers get paid. But regulators are conducting “risk adjustment data validation” (RADV) audits that compare patient medical codes submitted by health insurers with the actual codes that doctors put in patient medical records. The goal is to see if Medicare Advantage insurers are exaggerating people’s health conditions to get higher payments. An investigation from…” Read the full post here.
Source: Feds Are Ready to Claw Back Billions From Medicare Insurers — Do You Support the Move? – By Bob Herman, October 31, 2018. Axios.
