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.


Meet the Authors

Faegre Baker Daniels
Michael S. Adelberg

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

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