Member Tara Dwyer was recently quoted in Law360 Healthcare Authority regarding a federal ruling that could impact how the Centers for Medicare & Medicaid Services (CMS) conducts audits of Medicare Advantage plans. The ruling limits CMS from using small sample sizes to represent entire patient populations, which may challenge its goal of performing 550 audits annually to curb fraud and overbilling.

Tara says, “CMS will have to decide: Is it worth conducting those audits if we're only going to be able to recoup the errors in the actual samples? [The ruling] definitely impacts CMS's ability to have large-scale recoveries for things that they consider to be upcoding.”

Source

Law360 Healthcare Authority