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King & Spalding

CMS Expands Auditing of Medicare Advantage Plans

King & Spalding on

On May 21, 2025, CMS announced that it plans to increase its auditing efforts for Medicare Advantage (MA) plans. Effective immediately, CMS will audit all eligible MA contracts for each payment year in all newly initiated...more

Proskauer - Health Care Law Brief

CMS to Immediately Begin Auditing Medicare Advantage Plans in Significant Expansion of Enforcement Efforts

Proskauer - Health Care Law Brief on

On May 21, 2025, the Centers for Medicare and Medicaid Services (“CMS”) announced a significant expansion of its auditing efforts with respect to Medicare Advantage (“MA”) plans....more

Arnall Golden Gregory LLP

Insights From the 2025 American Health Law Association’s Long Term and Post-Acute Care Law and Compliance Conference

Arnall Golden Gregory LLP on

This year, health lawyers, providers, consultants, and government experts from across the country convened in Orlando, Florida, for the American Health Law Association’s Long Term and Post-Acute Care Law and Compliance...more

McDermott Will & Schulte

This Week in 340B: December 3 – 9, 2024

McDermott Will & Schulte on

Find this week’s updates on 340B litigation to help you stay in the know on how 340B cases are developing across the country. Each week we comb through the dockets of more than 50 340B cases to provide you with a quick...more

HaystackID

AI Healthcare Controversy Highlights Critical eDiscovery Challenges

HaystackID on

A landmark healthcare AI controversy has emerged as a watershed moment for eDiscovery professionals, revealing unprecedented challenges in investigating AI-driven decision-making systems within legal proceedings. The case,...more

Ankura

OIG Testimony Puts a Spotlight on Clinical Documentation and Payer Risk

Ankura on

In recent testimony before the United States House Committee on Energy and Commerce Subcommittee on Oversight and Investigations, Christi A. Grimm, Inspector General of the Department of Health and Human Services (HHS)...more

Groom Law Group, Chartered

CMS Medicare Advantage RADV Final Rule: No Fee-For-Service Adjuster, May Extrapolate Audit Findings Beginning with PY 2018

Groom Law Group, Chartered on

More than four years after it was proposed, on February 1, 2023 the Centers for Medicare & Medicaid Services (CMS) published the long-awaited risk adjustment data validation (RADV) Final Rule (Final Rule) that will affect...more

Ballard Spahr LLP

CMS Releases Final Rule for Risk Adjustment Data Validation Audit Methodology

Ballard Spahr LLP on

On January 30, 2023, CMS posted for inspection a final rule describing its Risk Adjustment Data Validation audit methodology (the Final RADV Rule). As we have discussed in prior alerts, the finalization of the RADV Rule,...more

Pillsbury Winthrop Shaw Pittman LLP

Bipartisan Spotlight on Medicare Advantage Risk Adjustment Fraud Likely to Spur Audits

Pillsbury Winthrop Shaw Pittman LLP on

Potential fraud and abuse in the Medicare Advantage Program (“MA Program”) has become the focus of two senior-ranking Senators on each side of the aisle—Chuck Grassley (R-Iowa) and Claire McCaskill (D-Mo.)—and this attention...more

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