For those that are audited, many submit hardship requests to account for missing patient records, and exclude certain patients from audits. In November, KHN obtained records from CMS of audits of 90 Medicare Advantage plans conducted from 2011 to 2013 plans.
One plan in these audits submitted 57 hardship requests, asking for records to be excluded, though only six of these were approved by CMS, KHN reported.
In other cases, plans asked for hardship exemptions when records were lost in floods, lost in warehouse fires, or lost when a provider was convicted of illegal opioid distribution.
CMS told KHN it approves around 20 percent of the hardship requests it receives.
Read the full report here.
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