Hill October 14, 2022
The Centers for Medicare and Medicaid Services (CMS) has agreed to publicly release dozens of private Medicare Advantage health plan audits to settle a 2019 lawsuit filed by Kaiser Health News (KHN).
KHN in September 2019 filed a lawsuit asking that CMS provide 90 government audits, including documents from the years 2011, 2012 and 2013.
These documents were reviews of the Medicare Advantage Risk Adjustment Data Validation. Risk adjustment is used by health insurance providers to determine expected medical costs of enrolled individuals.
KHN argued in its lawsuit that CMS was improperly withholding audits of Medicare Advantage plans, with these reviews allegedly having identified more than $650 million in improper charges.
By settling the lawsuit, CMS did not admit to...
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