A federal judge in Texas has vacated a rule that would have expanded the government’s ability to audit Medicare Advantage plans and claw back billions in alleged overpayments each year.
The rule, finalized in 2023, gave the Centers for Medicare and Medicaid Services (CMS) authority to extrapolate findings from audits of a sample of diagnosis codes across all enrollees of Medicare Advantage insurers. Historically, CMS had recouped overpayments only for diagnoses tied directly to the enrollees included in the sample, according to a report from BestWire. ARTICLE