CMS held back on audits, leading to billions in Medicare Advantage overpayments 

The Centers for Medicare & Medicaid Services (CMS) knew as far back as 2008 that certain Medicare Advantage plans were pocketing billions in overpayments, but officials still held back on auditing the plans and recouping payments tied to inflated risk scores, according to government records obtained by the Center for Public Integrity (CPI).Government records indicate that in 2008, CMS officials had already dubbed certain Medicare Advantage providers “high-flyers,” but the agency opted to conduct 30 audits each year, less than half of what it was capable of, according to CPI. In 2012, the agency announced it would conduct 30 risk adjustment data validation audits on 2011 claims data, aiming to collect overpayments by 2014. Those audits still aren’t finished, although a spokesperson told CPI the agency “anticipates” completion within the next year.

Source: CMS held back on audits, leading to billions in Medicare Advantage overpayments – FierceHealthPayerAntiFraud

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