On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The final rule codifies long-awaited regulations first proposed by CMS in 2018.
Based on findings of the Payment Accuracy Report recently issued by the Department of Health and Human Services (DHHS), six Democratic United States Senators questioned the Centers of Medicare and Medicaid Services’ (CMS) oversight and enforcement of Medicare Advantage (MA) plans. In a letter dated September 13, 2019, the Senators highlighted their belief that MA plans have been overbilling the federal government for years, specifically in excess of $30 billion dollars over the last three years.
The Senators requested that CMS provide a response on how the Agency intends to ...
Blog Editors
Recent Updates
- Podcast: 42 CFR Part 2 Final Rule: What’s Changing and What Do You Need to Know? – Diagnosing Health Care
- Congress Creates Yet Another Cliff for Medicare Telehealth Extensions (and We’re Running Out of Metaphors)
- OIRA Memo on Agency Deregulation: Implications for Health Care
- Outside Counsel’s Internal Investigations—Including Those Relating to Health Care—Are Privileged and Protected from Disclosure
- Podcast: Current Tailwinds in Women’s Health - What Do They Mean for Your Business? – Diagnosing Health Care