Analysis

Insurers Sweat Gov't U-Turn On Medicare Advantage Audits

By Jeff Overley (October 30, 2018, 11:03 PM EDT) -- The federal government has done a dramatic about-face on how much money it can recover through Medicare Advantage audits, a move that could force health insurers to pay back huge sums of money and halt industry momentum in False Claims Act litigation.

The reversal occurred late Friday in a proposed rule from the Centers for Medicare & Medicaid Services, which said it will abandon a policy adopted in 2012 that would have greatly cushioned the impact of audits that find excessive payments to Medicare Advantage insurers.

The policy, formally called an "adjuster," would have recognized an acceptable amount of excessive payments...

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