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The U.S. Centers for Medicare & Medicaid Services (CMS) announced a major expansion of its audit efforts for Medicare Advantage (MA) plans, aiming to crack down on overbilling and recover government funds.
“Beginning immediately, CMS will audit all eligible MA contracts for each payment year in all newly initiated audits and invest additional resources to expedite the completion of audits for payment years 2018 through 2024,” the agency said.
Key steps for audit efforts include adopting new technology to analyze medical records, expanding its team of medical coders from 40 to 2,000 by late 2025, and increasing the number of plans and records audited each year.
According to the CMS, the last major overpayment recovery came from a 2007 audit, despite estimates suggesting that MA plans overbill Medicare by $17B to $43B annually.
CMS, under President Donald Trump’s administration, will also work with the Department of Health and Human Services Office of Inspector General to recover unpaid overpayments identified in previous audits.
Insurer Humana (NYSE:HUM) is down about 4% and pharmacy provider CVS Health (NYSE:CVS) is down 4.2% after the bell.