The Government Accountability Office (GAO) issued a report stating that CMS paid as much as $14.1 billion in improper payments to Medicare Advantage organizations 3 years ago.
In order to mae sure government funding is not used to pay erroneous or fraudulent medical claims, the Centers for Medicare & Medicaid Services (CMS) conducts risk adjustment data validation (RADV) audits among Medicare Advantage organizations. This is meant to assist recover improper payments made to medical facilities that don’t have medical records supporting the healthcare services performed in the claim.
The Government Accountability Office (GAO) released a report claiming that CMS paid as much as $14.1 billion in improper payments to Medicare Advantage organizations 3 years ago. GAO also reported that there are no methods in place at CMS that allow them to choose the right contracts with the “the greatest potential for recovery of improper payments” to audit.
The report outlines that CMS doesn’t line up improper payment risk among contracts of Medicare Advantage organizations with “unsupported diagnoses.” In general, CMS does not use all accessible and present data to choose the contracts that are at the highest risk of improper payments.
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