Just before the government announced nearly $28 billion in fraud recoveries since 1997, The Centers for Public Integrity released a report indicating the feds have known about problems with Medicare Advantage risk scores since 2009. The report questions whether those recovery dollars could be a whole lot higher if the investigators were willing to target a payment system that appears to be flawed.
Insurers have even more incentive to earn high stars for their Medicare Advantage plans: According to a new analysis from Avalere Health, consumers increasingly choose plans with four or more stars.
Starting next year, health insurers must provide up-to-date doctor lists for their Medicare Advantage and Healthcare.gov policies, according to the Centers for Medicare & Medicaid Services.
The Centers for Medicare & Medicaid Services proposes a modest 0.95 percent reduction in Medicare Advantage payments to providers for 2016--a proposal that is not sitting well with the hospital sector.
The Centers for Medicare & Medicaid Services raised eyebrows when it proposed lower Medicare Advantage reimbursement rates for 2016, but the proposal isn't all bad news for Medicare Advantage plans.
The Department of Justice has requested information from Humana regarding risk adjustments assigned to Medicare Advantage beneficiaries, according to an annual report the insurance company filed to the Securities and Exchange Commission.
The Centers for Medicare & Medicaid Services claim that its proposal to cut Medicare Advantage reimbursement rates by 0.95 percent in 2016 will not impact insurers' revenue, but industry experts say the changes will hit their bottom lines.
The Centers for Medicare & Medicaid Services has proposed a 0.95 percent decrease in Medicare Advantage reimbursement rates for 2016. However, risk-scoring adjustments should give payers a 1.05 percent increase in total revenue, CMS said.
In what is believed to be the first case of its kind in South Florida, prosecutors are pursuing criminal fraud charges against a physician that overcharged Medicare Advantage plans. The case has pulled the health plan into the spotlight as it attempts to stave off spending cuts.
The healthcare industry continues to evolve in the post-Affordable Care Act market. A new Avalere Health report has summarized four key trends that will impact insurers this year as they update their business models to remain profitable and competitive.