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CMS tests waters for enhanced Medicare Advantage audits
Modern Healthcare

The federal government is examining how it can beef up medical record auditing of Medicare Advantage insurers, which have been accused of exaggerating patient diagnoses to pad their payments. New procedures outlined by the feds will lead to heftier payment recoveries, perhaps tens of millions of dollars more compared with past audits.The latest federal notice comes a few months after the CMS outlined a plan to expand Medicare’s Recovery Audit Program to Medicare Advantage, the private, managed-care version that competes with traditional Medicare.