On January 30, the Centers for Medicare & Medicaid Services (CMS) released a long-awaited final rule addressing how it will calculate and collect overpayments from Medicare Advantage (MA) plans arising from risk adjustment errors discovered through data validation audits.
In the final rule, CMS announces that it will recover excess premiums paid to MA plans when it finds unsupported or inaccurate plan-submitted risk adjustment data. CMS will not only recover the specific premiums associated with a specific error but will also extrapolate a plan’s error rate across entire cohorts of beneficiaries, thereby magnifying the potential scope of recoveries. In a related decision, CMS will not be using an adjuster to establish equivalence in error rates between MA data and risk adjustment data reported in the fee-for-service (FFS) Medicare program. The agency has granted plans some relief, deciding not to use extrapolation for audits that look back at 2011 through 2017 and beginning the extrapolation-based recoveries for the audits looking at the 2018 contract year.
The decision is expected to draw significant objection and litigation challenges from MA plans, which stand to lose significant funds under the rule. CMS projects that recoveries for 2018 alone will add up to $479 million. There will likely be downstream impact to providers and vendors who have been delegated risk or participate in value-based contracts for MA populations, and who profit based on...
The Dangote Group has denied claims that its President, Aliko Dangote, is at odds with Tony Elumelu, describing the report as false, malicious and baseless. In a statement signed by its Group Chie...