From the Justice Department pursuing legal action against several major payers and providers for alleged fraudulent risk adjustment coding practices, to payers looking to expand their markets despite more federal scrutiny, here are nine headlines about Medicare Advantage since June 5:
1. As the popularity of Medicare Advantage plans continues to rise, Family First CEO Evan Falchuk told Becker's July 8 that payers have the opportunity to improve members' care outcomes by offering caregiving support directly to family members.
2. Diabetes patients with Medicare Advantage plans were more likely to receive preventive treatments than those with fee-for-service Medicare plans and less likely to receive new, more expensive medications, according to a University of Pittsburgh Medical Center study published July 7.
3. Payers are working to expand their Medicare Advantage markets despite increased federal scrutiny, Forbes reported July 4.
4. At a House committee hearing June 28, oversight officials from across the federal government called on Congress to take action against Medicare Advantage plans found to be denying care to patients while overcharging the government billions of dollars every year.
5. A CMS rule revising Medicare Advantage and Part D marketing and communication regulations went into effect June 28 to increase oversight of third-party marketing organizations.
6. Beginning Jan. 1, UnitedHealthcare's Medicare Advantage members will be in network at Mayo Clinic facilities in the Midwest under a new contract agreement between the two organizations, the Star Tribune reported June 23.
7. On June 21, the U.S. Supreme Court declined to hear UnitedHealthcare's appeal of a CMS rule meant to recoup Medicare Advantage overpayments from payers. The federal rule, first implemented in 2014, requires a payer to refund payments to CMS within 60 days if it learns a diagnosis lacks medical record support. The argument stems from whether CMS must ensure there is actuarial equivalence between Medicare Advantage payments and traditional fee-for-service Medicare payments.
8. Despite 13 percent of claims being denied, most Medicare Advantage members are satisfied with coverage, according to an eHealth survey published June 13.
9. The U.S. Justice Department is pursuing legal action against several major Medicare Advantage payers and providers for alleged fraudulent risk adjustment coding practices, the Washington Post reported June 5.