June 16, 2022

Mike Adelberg Discusses Enforcement of One-Third Financial Audits With AIS Health

According to AIS Health’s RADAR on Medicare Advantage publication, the Centers for Medicare & Medicaid Services (CMS) imposed approximately $1 million in civil money penalties (CMPs) based on 2021 referrals, with nearly half stemming from one-third financial audit findings. In “Latest Audit Report Highlights Enforcement Activity Outside Program Audits,” Faegre Drinker Consulting Principal Mike Adelberg commented on the enforcement of one-third financial audits.

The CMS’s latest audit report showed that “a lot of Medicare Advantage Organizations (MAOs) got into trouble outside of the program audits on financial topics — MLR, one-third audits, solvency,” observed Adelberg. “This doesn’t automatically mean more intense scrutiny from regulators — it could just be the by-product of an enlarged pool of MAOs.”

The full article is available for RADAR on Medicare Advantage subscribers.

Full Article

Meet the Authors

Photo of Michael S. Adelberg
Michael S. Adelberg

Principal - Healthcare Providers & Plans Practice Lead - Faegre Drinker Consulting

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