In this episode of Health Law Simplified, hosts Sandy and Elizabeth unpack a pivotal federal court ruling that vacates a key CMS rule governing RADV audits in Medicare Advantage. Learn why the court struck down CMS’s extrapolation methodology and elimination of the Fee-for-Service Adjuster, and what this means for MA plans, compliance teams, and future rulemaking. We explore the procedural missteps that led to the ruling, its alignment with broader judicial scrutiny of CMS, and the potential ...
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In this episode of Health Law Simplified, hosts Sandy and Elizabeth unpack a pivotal federal court ruling that vacates a key CMS rule governing RADV audits in Medicare Advantage. Learn why the court struck down CMS’s extrapolation methodology and elimination of the Fee-for-Service Adjuster, and what this means for MA plans, compliance teams, and future rulemaking. We explore the procedural missteps that led to the ruling, its alignment with broader judicial scrutiny of CMS, and the potential ...
RADV Audits: Will CMS Crackdown Alter the Medicare Advantage Landscape?
Health Law Simplified
29 minutes
4 months ago
RADV Audits: Will CMS Crackdown Alter the Medicare Advantage Landscape?
In this episode of Health Law Simplified, we unpack a major shift in Medicare Advantage oversight: CMS’s sweeping expansion of its Risk Adjustment Data Validation (RADV) audit program. Beginning immediately, CMS will significantly expand its oversight by auditing all 550 eligible Medicare Advantage contracts each year – an ambitious leap from the previous annual review of just 60 plans. Hosts Sandy Durkin and Elizabeth Lippincott explore why CMS is cracking down, how it's scaling up with new ...
Health Law Simplified
In this episode of Health Law Simplified, hosts Sandy and Elizabeth unpack a pivotal federal court ruling that vacates a key CMS rule governing RADV audits in Medicare Advantage. Learn why the court struck down CMS’s extrapolation methodology and elimination of the Fee-for-Service Adjuster, and what this means for MA plans, compliance teams, and future rulemaking. We explore the procedural missteps that led to the ruling, its alignment with broader judicial scrutiny of CMS, and the potential ...
