Healthcare Dive
SEPTEMBER 6, 2023
Favorable selection of healthier beneficiaries led to overpayments in counties with high Medicare Advantage penetration, but benchmark changes could mitigate the impact, according to a study published in Health Affairs.
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.
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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).
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
Natalia Mazina
JULY 3, 2022
Back in 2017, the California Department of Healthcare Services (DHCS) approved a new methodology – National Average Drug Acquisition Cost (NADAC) – for reimbursing pharmacies for their drug cost. This lead to overpayments to pharmacies. NADAC prices significantly reduced pharmacy reimbursements. See a related blog post.
The Health Law Firm
FEBRUARY 20, 2018
Board Certified by The Florida Bar in Health Law On December 22, 2017, Kmart Corporation agreed to pay $32.3 By George F. Indest III, J.D., million to settle a whistle blower lawsuit alleging its pharmacies caused federal health programs to overpay for prescription drugs by not telling the government about discounted prices.
Innovaare Compliance
MARCH 1, 2022
Since 2017, benchmarks have been rising and in 2019, Medicare spent $321 more per person for MA enrollees than it would have spent for the same beneficiaries under traditional Medicare fee-for-service (FFS). 6] Improper payments can be overpayments and underpayments. 3] The bid is prepared from credible baseline pricing data.
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