The Centers for Medicare & Medicaid Services (CMS) on Monday finalized a stronger-than-expected payment update for Medicare Advantage (MA) plans in 2027, backing off from an earlier proposal from the agency that signaled flat funding, which triggered industry concern over benefit cuts and market exits.
CMS said the final rate...
The notion that a Republican administration would be inherently favorable to Medicare Advantage (MA) is being tested. From CMS’ decision to hold MA rates flat for next year, to the DOJ's continued enforcement actions related to MA billing and the OIG's heightened scrutiny of upcoding practices, MA stakeholders are preparing for a bumpy...
Although this presentation by the MedPAC Commission is informational only and includes no recommendations to Congress, it does include a variety of data and details on the 2024 Medicare Advantage (MA) market, including enrollment totals, vertical integration trends, payment policies and coding intensity changes year-over-year within MA...
Medicare Advantage insurers are still defrauding the Medicare program by inflating patient diagnostic codes. This week, one company settles with the federal government and another gets found out.
New York Medicare Advantage (MA) insurer Independent Health Corporation and it's (now defunct) subsidiary DxID ended their 12 year legal...
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced last month that it would investigate the use of prior authorization in denials for post-acute care by Medicare Advantage plans.
In the new audit, OIG plans to look into processes for reviewing prior authorization requests for post-acute...
As the popularity of Medicare Advantage has risen, so has scrutiny from the public and regulators. This week, the Wall Street Journal and KFF published analyses into two aspects of the financial success of Medicare Advantage plans.
In 2023, Medicare Advantage excelled in the metric known as gross margins, which means that MA plans...
A Maryland firm that oversees the nation’s largest independent network of primary care medical practices is facing a whistleblower lawsuit alleging it cheated Medicare out of millions of dollars using billing software “rigged” to make patients appear sicker than they were.
March 5, 2024
The civil suit alleges that Aledade...
As seniors, the Centers for Medicare and Medicaid Services (CMS) and Medicare Advantage (MA) plans gear up for a landmark Medicare Advantage Open Enrollment Period beginning October 15, Medicare Advantage on the whole is in hot water.
Last week, the New York Times published an earthshaking story documenting the extent to which...
Medicare Advantage (MA) is a tremendously popular program among not only beneficiaries but the policymakers and stakeholders who want to see the program work out. As an alternative to Traditional Medicare, hundreds of billions of dollars flow through MA plans, leaving a lot of room for fraud.
One major source of overcharging the...
The success of Medicare Advantage (MA) can't be understated. In the last 11 years, the program has grown to represent nearly 50% of the Medicare-eligible market, a benchmark it will likely pass within the next year.
Arizona MA growth reflects the program's national success. At the Hertel Report's 2020 Winter State of the State, Dan...
Throughout 2021, The Department of Justice (DOJ) cracked down on healthcare fraud, with special emphasis on fraud related to Medicare and Medicaid. As the population ages, Medicare Advantage plans have increased in popularity, leading to a direct increase in Medicare related fraud. The Department of Justice’s focus on healthcare fraud...National News
The Medicare Payment Advisory Commission (MedPAC), the panel that advises Congress on Medicare policy, released new findings last Friday that demonstrate a surge in popularity for the Medicare Advantage program but raises alarms about upcoding practices that have spiked Medicare spending.
Over 50% of Medicare beneficiaries are...National News
Last week Kaufman Hall released a report commissioned by the American Hospital Association predicting hospitals will continue to see depressed revenues this year the same month the Office of Inspector General found that before the pandemic hospitals were increasingly billing for inpatient stays at the highest severity level, which is the...
