News: CMS to begin aggressive auditing of MA plans dating back to 2018
On May 21, CMS announced that it will begin annual audits of all Medicare Advantage (MA) plans dating from 2018 to 2024, according to the American Hospital Association (AHA).
According to CMS, “federal estimates” suggest that MA plans “may overbill the government by approximately $17 billion annually.” Meanwhile, the Medicare Payment Advisory Commission estimates that “this figure could even be as high as $43 billion per year.”
The last “significant recovery” of MA overpayments, according to CMS, occurred in 2007.
“We are committed to crushing fraud, waste and abuse across all federal healthcare programs,” CMS Administrator Mehmet Oz, MD, MBA. “While the Administration values the work that Medicare Advantage plans do, it is time CMS faithfully executes its duty to audit these plans and ensure they are billing the government accurately for the coverage they provide to Medicare patients.”
To this end, CMS is pursuing its aggressive auditing through three measures:
- “Enhanced technology” (e.g., artificial intelligence)
- A “workforce expansion” (CMS will increase its team of medical coders from 40 to 2,000)
- “Increased audit volumes” (CMS will increase its yearly number of audits from 60 to 550)
CMS also noted that it will conduct these audits in conjunction with the Department of Health and Human Services Office of the Inspector General to recollect overpayments.
Editor’s note: To read the AHA summary, click here. To read the CMS announcement, click here.