The rule, finalized in 2023, gave the Centers for Medicare and Medicaid Services (CMS) authority to extrapolate findings from audits of a sample of diagnosis codes across all enrollees of Medicare Advantage insurers. Historically, CMS had recouped overpayments only for diagnoses tied directly to the enrollees included in the sample, according to a report from BestWire.
Texas judge strikes down federal rule targeting Medicare Advantage overpayments
- Niki Wilson
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