Health Law Advisor

FEBRUARY 2, 2023

As stated in the final rule, CMS intends to extrapolate RADV audit findings beginning with payment year (PY) 2018 but will not extrapolate RADV audit findings retroactively for PYs 2011–2017. billion between 2023 and 2032 from MAOs based on both non-extrapolated and extrapolated overpayment amounts. This total includes $41.1

Medicare 98

Medicare Medicare Overpayments Overpayment 98

Healthcare Law Blog

FEBRUARY 1, 2023

The Final Rule implements the following changes: CMS will extrapolate RADV audit findings beginning with payment year (“PY”) 2018 and will not extrapolate RADV audit findings for PYs 2011 through 2017. case number 18-5326 , which reinstated CMS’s Overpayment Rule for MA organizations. Becerra et al., 42 C.F.R. §§ 422.326(d), (c).

Medicare 105

Medicare Medicare Overpayments Overpayment 105

Hall Render

FEBRUARY 14, 2023

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.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

Healthcare Compliance Blog

MARCH 16, 2022

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.

Nursing Homes 59

Nursing Homes Nurses Overpayments Overpayment 59

Healthcare Law Blog

SEPTEMBER 28, 2023

Refresher on the RADV Final Rule The Final Rule will implement the following changes: CMS will extrapolate RADV audit findings beginning with payment year (“PY”) 2018, and will not extrapolate RADV audit findings for PYs 2011 through 2017, though it will continue to collect the non-extrapolated overpayments that are identified.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Kaiser Health News

JUNE 29, 2022

They also called for the Centers for Medicare & Medicaid Services, or CMS, to revive a foundering audit program that is more than a decade behind in recouping billions in suspected overpayments to the health plans, which are run mostly by private insurance companies.

Medicare 107

Medicare Medicare Governance Overpayments 107