CMS Intensifies Medicare Advantage Audits, LTC Research Highlights, and Nursing Home Compliance Issues

The Centers for Medicare & Medicaid Services (CMS) is increasing its auditing efforts on Medicare Advantage plans to identify potential upcoding and overpayment issues.

This regulatory focus aims to enhance compliance and reduce improper payments within the Medicare Advantage program. Meanwhile, research highlights that intensified monitoring of heart failure patients with comorbidities could reduce long-term care needs and rehospitalization rates, indicating opportunities for improved care management and payer/provider coordination in chronic conditions.

Additionally, a federal investigation is underway concerning nursing home COVID-19 policies during Andrew Cuomo's governorship, which may have implications for regulatory oversight and long-term care compliance. In another related development, a nursing home bookkeeper was discovered to have issued 223 bad checks totaling $377,000 prior to detection, emphasizing the importance of financial controls and fraud prevention within long-term care facilities.