Elevance Health has cleared an initial hurdle to avoid CMS enrollment and communications sanctions over some of its Medicare Advantage plans — but still faces two deadlines.
In February, CMS alleged that Elevance had submitted data corrections for unsupported diagnosis codes through encrypted external USB flash drives instead of the appropriate electronic systems over a span of seven years. A May 29 letter said Elevance completed its initial submission in CMS’ established electronic systems and sent a wire transfer of the total overpayment.
The letter also said the insurer has until June 30 to follow through with corrective action to avoid sanctions come July, while the insurer has until the end of July to avoid additional sanctions. CMS’ letter tasked Elevance with resolving risk-adjustment submissions and overpayment issues.
On the company’s first-quarter earnings call, Elevance President and CEO Gail Boudreaux said CMS extended Elevance’s deadline to July 31, beyond an earlier extension from March 31 to May 30. The company set aside $935 million to cover costs arising from the dispute.
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