The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced last month that it would investigate the use of prior authorization in denials for post-acute care by Medicare Advantage plans.
In the new audit, OIG plans to look into processes for reviewing prior authorization requests for post-acute...
A report from the Department of Health and Human Services (HHS) inspector general's office analyzed Medicare Advantage (MA) encounter data from 2016, stemming from concerns that MA organizations use chart reviews to inaccurately inflate risk adjusted payments. The result was billions in additional payments.
The Office of Inspector...
UnitedHealthcare won its case over a 2014 rule implemented by the Centers for Medicare and Medicaid Services (CMS) requiring that Medicare Advantage organizations report and return any identified overpayments. The rule was deemed arbitrary and capricious.
U.S. District Court Judge Rosemary Collyer vacated the rule in its entirety,...
