CMS To Conduct Contract-Level Audits Of Medicare Advantage Plans

The federal Centers for Medicare & Medicaid Services (CMS) is conducting contract level audits of its Medicare Advantage contractors to validate the risk adjustment data submitted by the plans and to recover overpayments. CMS announced the contract-level audits in the 2016 Medicare Advantage call letter. In that letter, CMS noted that the Risk Adjustment Data Validation (RADV) audits are CMS’s primary corrective action to recoup Part C improper payments, and CMS expects that “ payment recovery will have a sentinel effect on the quality of risk adjustment data submitted by plans for payment.”  However, the letter did not indicate . . .