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Illustration: Aïda Amer/Axios

Two years ago, the federal government created a plan to audit Medicare Advantage insurers more aggressively. But that plan is sitting in regulatory limbo.

Why it matters: The plan could claw back billions of taxpayer dollars. The delay is music to the ears of health insurers, which despise any form of enhanced audits.

What they're saying: A spokesperson for the Centers for Medicare & Medicaid Services confirmed to Axios that the proposed rule from 2019, which was already delayed twice to give the industry more time to analyze it, "has not yet been finalized."

  • The federal agency did not say why action hasn't been taken yet, but it is "committed to ensuring that Medicare Advantage plans submit accurate information to CMS so that payments to plans are appropriate," the spokesperson said.

The state of play: CMS is still conducting audits, known as "risk adjustment data validation," saying the audits are still "our main tool for conducting this oversight and ensuring appropriate payments."

  • CMS paused RADV audits at the outset of the pandemic last year, but quietly resumed them in September.
  • A lobbying group for smaller insurers asked CMS to "suspend all RADV audits for the duration of the COVID pandemic." The agency has declined to do so.

Yes, but: Those audits were falling short at catching the biggest instances of fraud — which is what inspired the plan for enhanced audits in the first place.

Go deeper: Medicare has become more of a private marketplace — and it's costly

Go deeper

Oct 15, 2021 - Health

Democrats' attempt to lower private drug prices is likely to fail

Illustration: Aïda Amer/Axios

The Democrats' most significant attempt to rein in health care costs in the private market— specifically prescription drug costs — is increasingly likely to fail.

Why it matters: U.S. health care costs have ballooned over the last few decades. But there's fierce industry resistance to allowing the government to step in and regulate private market prices. Plenty of lawmakers hate the idea as well.

1 hour ago - Technology

Scoop: Facebook exec warns of "more bad headlines"

Illustration: Annelise Capossela/Axios

In a post to staffers Saturday obtained by Axios, Facebook VP of global affairs Nick Clegg warned the company that worse coverage could be on the way: “We need to steel ourselves for more bad headlines in the coming days, I’m afraid.”

Catch up quick: Roughly two dozen news outlets had agreed to hold stories based on leaked materials from Facebook whistleblower Frances Haugen for Monday publication — but the embargo fell apart Friday night as participating newsrooms posted a batch of articles ahead of the weekend.

"Atmospheric river" to whiplash Northern California from drought to flood

A map depicting 24-hour preciptation forecast (inches) ending Monday at 5a.m. local time. Photo: NOAA

A series of powerful "atmospheric river" storms are set dump historic amounts of rainfall across parts of drought-stricken California and the Pacific Northwest from this weekend, forecasters warn.

Why it matters: A strong atmospheric river, packing large amounts of moisture, is predicted to whiplash Northern California from drought to flood.