News & Analysis as of

Final Rules › Overpayment › Medicare Advantage

Proskauer - Health Care Law Brief

CMS Publishes Final Rule, Effective January 1, 2025, Addressing the Requirements for Reporting and Returning Overpayments

Proskauer - Health Care Law Brief on

The standard for an “identified overpayment” under Medicare Parts A–D now aligns with section 1128J(d)(4)(A) of the Social Security Act, which incorporates by reference the Federal False Claim Act’s (the “FCA”) “knowledge”...more

Goodwin

Watch the Clock! CMS Makes Important Changes to Medicare Overpayment Rules

Goodwin on

The Centers for Medicare & Medicaid Services (CMS) recently made meaningful changes to its regulations interpreting the Affordable Care Act’s (ACA’s) so-called “60-day Rule,” which requires Medicare providers to affirmatively...more

Proskauer - Health Care Law Brief

CMS Proposes Additional Modifications to the Overpayment Rule Relating to the Deadline for Reporting and Returning Overpayments

Proskauer - Health Care Law Brief on

In the context of Medicare Advantage (“MA”) reform initiatives, we previously addressed the Centers for Medicare & Medicaid Services’ (“CMS”) December 27, 2022 proposal to amend its regulations set forth at 42 C.F.R. §...more

King & Spalding

CMS Issues Final Rule on Medicare Advantage Risk Adjustment Data Validation Program

King & Spalding on

On February 1, 2023, CMS published its final rule addressing the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. CMS uses RADV audits to identify whether Medicare made overpayments to MA plans by...more

Bass, Berry & Sims PLC

CMS Finalizes Long-Awaited RADV Program Rule

Bass, Berry & Sims PLC on

On February 1, the Centers for Medicare & Medicaid Services (CMS) published the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) Program Final Rule (Final Rule), which will take effect on April 3, 2023. The...more

Troutman Pepper Locke

CMS Publishes Final Rule Increasing Government Authority to Recover Overpayments from Medicare Advantage Plans

Troutman Pepper Locke on

On February 1, the Centers for Medicare & Medicaid Services (CMS) published a final rule strengthening their authority to recover alleged overpayments made to Medicare Advantage plans. The rule formalizes the Medicare...more

Jones Day

D.C. District Court Vacates 60-Day Medicare Advantage Overpayment Rule

Jones Day on

The Situation: In 2016, several Medicare Advantage ("MA") organizations challenged a 2014 final rule promulgated by the Center for Medicare Services ("CMS") that broadly subjected MA organizations to potential liability under...more

Holland & Knight LLP

CMS Announces Final Regulatory Changes to Medicare Advantage and Part D

Holland & Knight LLP on

- CMS issues final Medicare Advantage and Part D regulatory changes after a controversial proposed rule was announced earlier this year. - New requirements for the reporting and return of Medicare Advantage and Part D...more

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