Lexology April 13, 2023
The Medicare Act does not expressly provide for judicial review of overpayment determinations made by the Centers for Medicare & Medicaid Services (CMS) under the agency’s controversial Risk Adjustment Data Validation (RADV) program for Medicare Advantage (MA) organizations. With the first wave of such overpayment determinations expected in the coming months, MA organizations impacted by RADV audits should begin considering a potential route to judicial review of such overpayment determinations and whether courts may deem exhaustion of administrative remedies a prerequisite to judicial review.
The RADV Final Rule
As we reported earlier this year, CMS recently published a much-anticipated final rule implementing changes to the RADV program. In that program, CMS audits particular contracts between CMS and MA organizations by...
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