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Ambiguity Surrounding MAO Claim Denials Hampers Fraud Detection

Investigation included 55 million records from 2019. Adjustment codes are sometimes too vague to clearly identify whether a Medicare Advantage Organization (MAO) denied payment for a service, the Office of Inspector General (OIG) concluded in a February 2023 Issue Brief. Without specifics about the services for which the MAO is denying payment, the OIG cannot […]

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