News Briefs: CMS Will Release Results From 90 Audits of MA Plans’ Risk Adjustment Data

November 3

Settling a lawsuit filed by Kaiser Health News, CMS has agreed to release the results of 90 Risk Adjustment Data Validation (RADV) audits of Medicare Advantage plans for payment years 2011 through 2013, KHN reported. The news outlet in September 2019 filed the suit under the Freedom of Information Act in an effort to make public “vital information” about the estimated $600 million in overpayments the government aims to collect from plans through those completed RADV audits, said KHN. Under the settlement, CMS will share audit spreadsheets showing which medical diagnoses could not be confirmed but will redact the payment amounts. The agency has already sent the first round of records, according to KHN.

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Radar on Medicare Advantage

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.