Medicare Advantage in the headlines: 10 recent updates

Humana is the latest insurer facing a lawsuit over allegedly using automated tools to deny Medicare Advantage members' claims, and Molina expects its acquisition of Bright Health's Medicare Advantage business to close soon. 

Here are 10 Medicare Advantage updates Becker's has reported since Dec. 4. 

1. Molina Healthcare reduced its offer for Bright Health's California Medicare Advantage business. The company said it would pay $425 million, net of any tax benefits, for Bright Health's Medicare Advantage business, down from its originally announced purchase price of $510 million. The companies expect the deal to close on or around Jan. 1. 
   
   

2. The Federation of American Hospitals asked CMS to include how often Medicare Advantage carriers uphold or overturn initially denied prior authorization requests into how the agency calculates star ratings for the program.
   
   
3. Health Care Service Corp. and Elevance Health are vying for Cigna's Medicare Advantage business, Bloomberg reported Dec. 15. The report comes after a potential merger between Humana and Cigna fell through.  
   
   

4. CMS will implement new risk adjustment payment rates, prior authorization requirements and network standards for Medicare Advantage plans in 2024. Here are five changes coming to the program next year. 
   
   

5. Humana allegedly used an artificial intelligence tool owned by UnitedHealth Group to wrongfully deny Medicare Advantage members' medical claims, according to a class-action complaint filed Dec. 12. The suit is the latest legal action against major insurers such as UnitedHealthcare and Cigna for allegedly using automated data tools to wrongfully deny members' claims.
   
   

6. A bipartisan group of senators said lawmakers don't have enough data on Medicare Advantage to properly oversee the program. Sens. Bill Cassidy, MD, Elizabeth Warren, Marsha Blackburn and Catherine Cortez Masto penned a letter to CMS Administrator Chiquita Brooks-LaSure. The lawmakers urged the agency to require plans to submit more data on prior authorizations. 
   
   

7. Groups advocating on behalf of older adults and people with disabilities asked federal agencies for a "full-scale investigation" following what they say are misleading Medicare Advantage advertising practices by UnitedHealthcare.
   
   

8. The Medicare Advantage 'gold rush' is slowing down, according to Wall Street Journal columnist David Wainer. 
   
   

9. Louisville, Ky.-based Baptist Health will be out of network with UnitedHealthcare and Centene's Wellcare Medicare Advantage plans, effective Jan. 1, 2024. The health system's medical group previously went out of network with Humana's Medicare Advantage and commercial health plans in September.
   
   

10. HHS Office of Inspector General audits found over $213 million in estimated Medicare Advantage overpayments in 2023. Here are 10 plans audited by CMS in 2023.