CMS' decision to crack down on Medicare Advantage auditing could have done more to stop overpayments, professors and students of public health wrote in Health Affairs.
A group of professors and students from Georgia State University School of Public Health and College of Law in Atlanta, Providence, R.I.-based Brown University School of Public Health, and the University of Michigan School of Public Health in Ann Arbor broke down the impacts of CMS' final rule in an article published in Health Affairs March 1.
CMS issued a final rule Jan. 30 to implement stricter audits of Medicare Advantage plans, a move that could leave payers on the hook for billions of dollars in repayments to the federal government.
Neither side — insurers or CMS — is truly happy with the ruling, the authors write. In a win for insurers, CMS will not extrapolate overpayments before 2018.
"The agency's justification of its decision not to extrapolate back to ... 2011 appears thin in the face of its fiduciary duty to safeguard the Medicare Trust Funds," the authors wrote.
To strengthen its collection of overpayments, the authors recommend requesting more funding and resources to expedite the appeals process for audits, thereby recouping payments faster.
The authors also suggest expanding the Medicare recovery audit contractor program to Medicare Advantage.
Read more here.