Bill Introduced to Combat Medicare Advantage Upcoding

The legislation aims to reduce overpayments to Medicare Advantage (MA) plans.

A pair of U.S. Senators have put forth a bill to oppose upcoding in MA by eliminating incentives for plans to overcharge.

The No Unreasonable Payments, Coding, or Diagnoses for the Elderly Act, or No UPCODE Act, has been introduced by senators Bill Cassidy (R-La.) and Sen. Jeff Merkley (D-Ore.) in the midst of MA plans taking heat for receiving billions of dollars in overpayments.

CMS has released its Medicare Advantage Risk Adjustment Data Validation final rule to claw back those overpayments, but the rule will only apply to audit findings beginning with the payment year 2018.

“Federal audits have found that taxpayers have been overpaying bad actors...

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