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.