More Rigorous Audits Coming to Medicare Advantage

Insurers offering Medicare Advantage plans need to ready themselves for more intense reviews by federal auditors. The Centers for Medicare and Medicaid Services in late January finalized a controversial rule laying out a new approach for how it will recoup improper risk adjustment payments made to MA plans. CMS’ 2018 proposed rule on the audit program garnered significant criticism from Medicare Advantage Organizations and the final rule is no different.

Under the new methodology, CMS expects to collect $4.7 billion in improper payments over the next 10 years, a significant escalation from previously projected recoveries. The first payments will be due in 2025.

Below we...