Payers looking to expand Medicare Advantage markets despite increased scrutiny

Payers are working to expand their Medicare Advantage markets despite increased federal scrutiny, Forbes reported July 4. 

Six things to know: 

1. At a June 28 House committee hearing, 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 by billions of dollars every year. 

2. The Justice Department is reportedly pursuing legal action against several Medicare Advantage payers and providers for alleged fraudulent risk adjustment coding practices, where medical records are altered to make patients appear sicker than they actually are.  

3. In the coming weeks, major payers like UnitedHealthcare, Aetna, Cigna and Elevance are expected to report strong second-quarter performance of their Medicare Advantage operations, according to Forbes

4. Startups and regional health plans are using funds from their financial backers and investors to expand into new Medicare Advantage markets despite a competitive landscape and volatile financial market, according to the report. 

5. Despite the increased scrutiny, Medicare Advantage programs continue to be supported by the Biden administration and bipartisan members of Congress, according to Forbes. 

6. Medicare Advantage plans added more than 2 million beneficiaries in 2022 and currently represent 45 percent of all Medicare enrollment. 

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