Health Insurers Gird for Audits of Medicare Managed Care Claims, Bloomberg Law

Partner Kathleen McDermott spoke to Bloomberg Law about how the Centers for Medicare and Medicaid Services use discretion on when, how, and whether to extrapolate audit findings in Medicare Advantage Plans. Kathleen said because the plans rely on third-party medical providers for diagnoses and medical records, they cannot fully guarantee accuracy in their claims.

“So, they’ve got to be able to use data analytics to spot potential improper claims or data that are being generated by their provider network,” Kathleen said.

Read the full Bloomberg Law article >>

Subscription may be required.