Since 2021, the OIG has issued 24 audit reports, and four of the reports have been published so far in 2023. These audits identified more than $400 million in overpayments, with approximately 72% of audited HCCs not validated / supported within the medical documentation The Office of
Read More →It’s crucial for health plans and plan sponsors to verify the accuracy and timeliness of benefit documents, such as Certificates of Coverage, Summary Plan Descriptions, and Evidence of Coverages, as they finalize annual changes to benefit plan designs. Some plans have discovered during audits by a Department
Read More →CMS has initiated routine program audits by sending engagement letters to Medicare Advantage organizations, prescription drug plans and Medicare-Medicaid plans. Are You Audit-Ready? If your plan receives an engagement letter, are you prepared to respond within 15 business days, or do you feel nervous and hope you
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