New CMS Medicare Advantage audit rule lacks information, Humana execs say

CMS' new Medicare Advantage auditing standards did not include enough information about auditing methods to understand its full impacts, Humana executives said on a Feb. 1 investor call

"We look forward to working with CMS to learn more about the methodology, including contract selection, sampling and extrapolation as the rule did not provide the details needed to fully understand the potential impact of the future audits," Humana CEO Bruce Broussard said on the call. 

Mr. Broussard told investors the company is "disappointed" that CMS eliminated the fee-for-service adjuster from MA audits, which allows for a permissible number of payment errors. 

Payer executives, including Humana CFO Susan Diamond, have said the industry is likely to resort to litigation if the FFS adjuster was eliminated. 

Mr. Broussard told investors Humana is "considering all our options to address or challenge" the elimination of the FFS adjuster. 

Bloomberg identified Humana as the payer that could stand to lose the most in clawbacks from CMS. 

Mr. Broussard told investors Humana's payment error rate should not be different from other companies. 

"I would just say that we don't have any reason to think that the inherent error rate within the Humana population would be meaningfully different from others," Mr. Broussard said. "So [that] may be just reflective of the audit selection and process that they've used historically."

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