The federal government will audit Medicare Advantage insurers aggressively under a rule finalized Monday, which is expected to result in billions of dollars in overpayments going back toward Medicare’s trust fund and patients over the next decade.
However, federal officials watered down one of the auditing policies by giving insurers seven years of immunity from having the samples of their diagnosis coding errors extrapolated to their broader Medicare Advantage membership.
The rule, which was proposed in 2018 and has been part of a decade-long feud between the health insurance industry and regulators, will apply to all Medicare Advantage plans and likely will invite lawsuits from industry groups.
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