On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released an Audit and Enforcement Report summarizing its annual Medicare Advantage (Part C) and Prescription Drug (Part D) program ...
To tighten oversight and minimize overpayments to Medicare Advantage plans, the Centers for Medicare & Medicaid Services (CMS) introduced a new rule in 2023 that revamped the agency’s approach to risk ...
On September 25, a federal district court vacated the Medicare Advantage risk adjustment and data validation (“RADV”) final rule that would have enabled the Centers for Medicare & Medicaid Services ...
For this audit, we reviewed one MA organization, Cigna-HealthSpring Life & Health Insurance Company, Inc. (Cigna), and focused on nine groups of high-risk diagnosis codes. Our objective was to ...
The CMS’ first audit of an insurer for compliance with a law preventing surprise bills for consumers found some evidence to support provider allegations that insurers are gaming the system to lower or ...
An official from the Centers for Medicare and Medicaid Services said the organization would perform an “audit audit” to investigate claims about the increasing number of audits, according to a ...
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