Healthcare DIVE January 31, 2023
Federal regulators likely will claw back billions of dollars in overpayments made to Medicare Advantage plans beginning in 2018, backtracking from an earlier proposal that sought to collect on overpayments made to insurers more than a decade ago.
Regulators had proposed to go back further, reaching back as far as 2011 to claw back overpayments. The CMS released the final rule on Monday for health insurers that operate Medicare Advantage plans, which cover about 29 million Americans.
One key change is that regulators will extrapolate from a small subset of audits and apply the error rate to the insurer’s Medicare Advantage business.
Before, insurers didn’t have to worry about these audits financially, Ted Doolittle, former deputy director...
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