CMS Sets Tougher Penalties For Improper Medicare Advantage Charges
The Centers for Medicare and Medicaid Services estimates that it could claw back $4.7 billion over 10 years from pending audits of private Medicare Advantage insurers' charges. The companies didn't get the leniency they sought for diagnostic errors, which could set up court challenges. Insurers did a major reprieve from returning overpayments from 2011 to 2017.
Stat:
Medicare Advantage Insurers To Repay Billions Under Audit Rule
The federal government will audit Medicare Advantage insurers aggressively under a rule finalized Monday, which is expected to result in billions of dollars in overpayments going back toward Medicare’s trust fund and patients over the next decade. (Herman and Bannow, 1/30)
AP:
Feds Expect To Collect $4.7B In Insurance Fraud Penalties
The Biden administration estimated Monday that it could collect as much as $4.7 billion from insurance companies with newer and tougher penalties for submitting improper charges on the taxpayers’ tab for Medicare Advantage care. Federal watchdogs have been sounding the alarm for years about questionable charges on the government’s private version of the Medicare program, with investigators raising the possibility that insurance companies may be bilking taxpayers of billions of dollars every year by claiming members are sicker than they really are to receive inflated payments. (Seitz, 1/30)
Bloomberg:
Medicare Advantage Health Plans Face $4.7B Clawback From Federal Audit Rule
The rule, which governs audits of Medicare Advantage insurers by the Centers for Medicare and Medicaid Services, is stricter than the industry had lobbied for. It finalized a 2018 proposal for auditing the private plans that administer programs for the agency, a move intended to recover excessive payments based on exaggerated claims of patient illness. (Tozzi, 1/30)
Modern Healthcare:
CMS Finalizes RADV Rule For Medicare Advantage Plans
CMS’ approach to these audits will be significantly different than under the previous policy. Instead of reviewing samples of insurers’ claims to determine if they were correctly paid, the agency will extrapolate the error rates from those reviews and apply them to the whole plan. The proposed rule would have been retroactive to 2011, but CMS instead will limit its scope to 2018 onward. (Berryman, 1/30)
KHN:
Government Lets Health Plans That Ripped Off Medicare Keep The Money
Medicare Advantage plans for seniors dodged a major financial bullet Monday as government officials gave them a reprieve for returning hundreds of millions of dollars or more in government overpayments — some dating back a decade or more. The health insurance industry had long feared the Centers for Medicare & Medicaid Services would demand repayment of billions of dollars in overcharges the popular health plans received as far back as 2011. (Schulte, 1/30)
