The Medicare Advantage program has serious structural problems that lead to overpayment and policymakers must take action on MedPAC’s recommendations in order to create a more cost-effective program, an issue brief from the Urban Institute found. “MA plans have reduced health care utilization, but although MA was also supposed to generate Medicare program savings, it never has,” the brief explained. “Policy groups such as the Medicare Payment Advisory Commission (MedPAC) have long understood and explained that MA plans are overpaid rela ...
According to section 1128J(d) of the Social Security Act, a provider must report and return a self- identified overpayment to its Medicare Administrative Contractor (MAC) within: ● 60...
The Centers for Medicare & Medicaid Services (CMS) released highly anticipated updates this month to the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Overpayment Statute). The result is a mixed bag. In a qualified win for providers, CMS adopted a new definition of what it means to have "identified" an overpayment that triggers the 60-day report-and-return clock under the federal Overpayment Statute, finally abandoning its doomed "reasonable diligence" ...
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Studying Medicare Advantage plans for overpayment, OIG found that Cigna-HealthSpring of Tennessee may have raked in $5.9 million in overpayments in 2016 and 2017.
Research Areas : Health and health care, Tags : Medicare, Policy Centers : Health Policy Center
The Centers for Medicare & Medicaid Services (CMS) released highly anticipated updates this month to the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Ove...
Medicare Advantage plans could see rates dip slightly in 2025 The CMS proposed a 0.2% dip in MA rates. However, analysts said regulators will likely improve the payment rate in the final...
This final rule requires providers and suppliers receiving funds under the Medicare program to report and return overpayments by the later of the date that is 60 days after the date on which the ov...
Sutter Health LLC, a California-based healthcare services provider, and several affiliated entities, Sutter East Bay Medical Foundation, Sutter Pacific Medical Foundation, Sutter Gould Medical Foundation, and Sutter Medical Foundation, have agreed to pay $30 million to resolve allegations that the affiliated entities submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans, which resulted in the plans and providers being overpaid, the Justice Department announced today. Sutter Health is head ...