CMS cracks down on Medicare Advantage claims

The Centers for Medicare & Medicaid Services has announced it will tighten financial scrutiny of Medicare Advantage plans, reported the Associated Press and Bloomberg News.

Part of the intention of the auditing is to eventually end the practice of "pay-and-chase," wherein CMS investigators try to recover payments from claims that already have been improperly reimbursed.

CMS reports that as much as 11 percent of payments it made to Medicare Advantage plans were in error last year and may have made more than $12 billion in overpayments. It intends to audit 30 unnamed plans and compare their clinical records to claims submitted.

"We're absolutely confident that this is a valid sample to do these audits," said Jonathan Blum, a deputy Medicare administrator. However, CMS decided to only perform one year of audits, rather than five years as it had originally proposed.

Altogether, CMS officials believe its audits will lead to the recovery of about $370 million in overpayments from 2011, and that the amount would increase in the intervening years.

To learn more:
- read the Bloomberg News article
- get the Associated Press article
- read the CMS Blog entry