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Unpacking the OIG Audit: Medicare Advantage Overpayments & the Power of Medical Necessity

All Days
Human Resources | Recorded Webinar | Duration: 90 Minutes
Keisha Wilson
Live webinar instructions will be emailed to you 3 days prior to the event. || The recording, digital download, and full transcript will be available within 48 hours after the webinar.
Description
  • Identify key findings from recent OIG audits related to Medicare Advantage overpayments and examine the recent OIG audit findings from June 2025.
  • Understand the Link Between Medical Necessity and Risk Adjustment. Explore how diagnoses not supported by medical necessity contribute to inflated risk scores and improper payments, and why this remains a key area of concern for the OIG and CMS.
  • Get a refresher on the most relevant ICD-10-CM Official Guidelines for Coding and Reporting, emphasising selection of chronic conditions and the importance of MEAT (Monitor, Evaluate, Assess/Address, Treat) documentation.
  • Evaluate Your Documentation Through the Lens of OIG Auditors. Use real-world examples to test whether documentation meets the medical necessity criteria and understand what auditors are really looking for during risk adjustment reviews.
  • Implement Best Practices to Safeguard Against Overpayments and Audit Exposure.
  • The Role of Training & Education in Compliance: Why ongoing education is essential for risk.

  • Key Takeaways

  • How to identify key findings from recent OIG audits related to Medicare Advantage overpayments.
  • How lack of medical necessity contributes to improper risk adjustment coding and
  • reimbursement.
  • How to apply ICD-10-CM coding guidelines accurately to support compliant diagnosis capture and
  • medical necessity.
  • The process of Evaluate documentation practices to ensure alignment with CMS guidelines and medical
  • necessity standards.
  • Precisely Implement proactive strategies to reduce audit risk and ensure compliance with Medicare
  • Advantage regulations.
  • Recognize how continuous training reduces risk, improves documentation, and strengthens organizational compliance.

  • This webinar benefits the following agencies-

  • Hospitals
  • Clinics
  • Physician practices
  • Compliance teams
  • Coders
  • Auditors
  • Third party vendors
  • Home Health Agencies
  • RCM teams

  • Who should attend?

  • Hospitals
  • Clinics
  • Physician practices
  • Compliance teams
  • Coders
  • Auditors
Rhanda McKown

Keisha Wilson

Keisha Wilson, CCS, CPC, CPCO, CPMA, CRC, CPB, AAPC Approved Instructor, the founder/ CEO of KW Advanced Consulting, is a seasoned professional with over 20+ years of experience in the healthcare field. Her career in large teaching hospitals and acute ambulatory care systems includes roles such as an outpatient coding specialist, clinical documentation improvement (CDI) specialist, compliance operations coding and billing manager, interim compliance director, and consultant to various coding companies. Her extensive experience is a testament to her leadership and deep understanding of the industry.

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