Becker's Healthcare September 27, 2024
HHS’ Office of Inspector General has published audits of four Medicare Advantage plans in the past two months.
The OIG frequently audits Medicare Advantage plans to determine if diagnosis codes submitted to CMS are in line with federal requirements.
Diagnosis codes determine how much MA plans are reimbursed by CMS. Nearly every major Medicare Advantage plan has faced or settled allegations of upcoding, the practice of making patients appear sicker than they are on paper to receive higher reimbursements from CMS.
In 2023, CMS implemented tougher auditing standards on Medicare Advantage plans. The move could leave payers on the hook for billions in repayment to the federal government.
As part of the final rule, the OIG...
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