RADV Rule Sets MA Overpayment Recoup Strategy, Nixes FFS Adjuster

CMS on Monday (Jan. 30) announced it will extrapolate Medicare Advantage audit data beginning with payment year 2018 as it moves to claw back overpayments with its long-awaited Medicare Advantage Risk Adjustment Data Validation (RADV) rule . Dara Corrigan, director of the Center for Program Integrity, said the agency anticipates retroactively recouping $479 million in overpayments from payment year 2018, and forecasts recovering around $4.7 billion between 2023 and 2032 based on the new audit structure. The department will not...