CMS is stepping up efforts to audit Medicare Advantage plans, and federal lawmakers are reintroducing legislation aimed at simplifying prior authorization in the program.
Here are seven Medicare Advantage updates Becker’s has reported since May 12:
- CMS announced an “aggressive” plan to step up oversight of Medicare Advantage. The agency will audit every MA plan for potential overpayments annually, hiring more than 1,000 medical coders to support the effort.
- Federal lawmakers reintroduced the “Improving Seniors’ Timely Access to Care Act,” a bipartisan bill that aims to streamline the prior authorization process for Medicare Advantage enrollees. The Better Medicare Alliance, Humana, American Hospital Association and American Medical Association have all backed the bill.
- Florida Blue lost its challenge to its Medicare Advantage star ratings. A federal judge ruled the insurer is not entitled to have its MA star ratings reevaluated.
- A group of lawmakers urged a federal court to allow a lawsuit alleging UnitedHealth Group overcharged the federal government for Medicare Advantage claims to continue. In an amicus brief, 29 representatives argued the nearly decade-old case should proceed to a jury trial.
- UnitedHealth Group is under criminal investigation by the Justice Department for alleged Medicare Advantage fraud, The Wall Street Journal reported. UnitedHealth Group said it is not aware of any criminal investigation, and called the Journal’s reporting “irresponsible.”
- The higher medical costs that have hurt UnitedHealth Group’s Medicare Advantage business are beginning to crop up in other lines of business, CFO John Rex told investors.
- On average, insurers pay 4.7% higher commercial prices to hospitals that are a part of their Medicare Advantage networks compared to those not in network, according to a new study published in Health Services Research.
