John Tilton

Sheppard Mullin Richter & Hampton LLP

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Medicare Advantage RADV Audit Final Rule Challenged in Court

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. Among other...more

9/28/2023 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs)

CMS Issues Long-Awaiting Medicare Advantage RADV Final Rule

On January 30, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final...more

2/2/2023 / Audits , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Final Rules , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , OIG , Overpayment Recovery Time Limits

CMS Pushes Publication of Final FFS Adjuster for RADV Audits Rule to February 1, 2023

CMS announced today a further extension until February 1, 2023, of the deadline for its publication of the long-awaited final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster)...more

11/2/2022 / Audits , Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Medicare Advantage Organizations (MAOs) , Medicare Part A , Medicare Part B , Social Security Act

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