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billion in overpayments from MAOs for payment years 2011 through 2017. Further, CMS estimates that beginning with payment year 2018, it will identify approximately $479 million per audit year in overpayments to MAOs. Background RADV audits are the main tool that CMS uses to correct overpayments made to MAOs.
It is alleged that between January 2011 and November 2014, the Georgia nursing home submitted claims to Medicare for unreasonable, unnecessary, and unskilled services for rehabilitation therapy. The Georgia nursing home agreed to pay $400,000 to resolve the allegations. This amount was based on the nursing home’s ability to pay.
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