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Increased oversight seems set to focus most intensely on risk-adjustment data validation (RADV), which confirms medical records support diagnoses used for patients. Noting in its recent announcement ...

The Biden administration needs to back off a massive overhaul to risk adjustment audits for Medicare Advantage (MA) plans, according to insurers that say the proposal unfairly targets prior audits ...

Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans for seniors, with some plans overbilling the government more than $1,000 per ...

Risk adjustment is hugely important in Medicare Advantage (MA). Risk adjustment is intended to adjust for the underlying severity of enrollees’ health conditions and appropriately compensate private ...

The CMS will crack down on overpayments to Medicare Advantage plans, moving to significantly expand its capacity to audit whether insurers are inflating their enrollees’ illnesses, the agency said ...

Medicare lost out on $2.8 million in savings in 2020 by incorrectly implementing price reductions on Medicare Part B drugs, an HHS Office of Inspector General audit found. Medicare Part B covers drugs ...

The CMS has provided a long-awaited update on how it plans to approach Medicare Advantage audits, five months after a federal judge threw a wrench in the agency’s plan to drastically expand the money ...

This story is free to read because readers choose to support LAist. If you find value in independent local reporting, make a donation to power our newsroom today. Newly released federal audits reveal ...

Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans for seniors, with some plans overbilling the government more than $1,000 per ...