Radar on Medicare Advantage

Facing Low MDPP Supplier Interest, CMS Floats Model Changes

Hoping to boost enrollment in the struggling Medicare Diabetes Prevention Program (MDPP) expanded model, CMS has proposed changes that would increase reimbursement and significantly shorten the services period for p...
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© 2024 MMIT

News Briefs

✦ In the latest False Claims Act settlement involving allegations of Medicare Advantage “upcoding,” Sutter Health and its affiliates agreed to pay $90 million to resolve claims that they knowingly submitted in...
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© 2024 MMIT

UnitedHealthcare, Aetna Dominate as EGWP Market Grows

Enrollment in Employer Group Waiver Plans (EGWPs) grew 19.5% from 2018 to 2021, at an average rate of about 6% per year, according to the August 2021 update to AIS’s Directory of Health Plans. About 18% of all Med...
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© 2024 MMIT

New Ruling Has Major Overpayment Implications for MAOs

Nearly three years ago, a federal court’s ruling in support of UnitedHealth Group threw a seemingly definitive wrench into CMS’s plans to begin recouping self-identified overpayments from Medicare Advantage insu...
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© 2024 MMIT

MTM Report Illustrates Challenges of Testing Part D Changes

As CMS looks to scale back its many models and refocus on health equity, the Center for Medicare and Medicaid Innovation (CMMI) is winding down two Medicare Part D models that were intended to test whether giving pl...
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© 2024 MMIT

Brooks-LaSure Stresses Health Equity as CMS Considers Future Demonstrations

CMS will refocus and redouble its efforts on health equity and whole-person health outcomes as the Biden administration evaluates ongoing and potential programs and initiatives, CMS Administrator Chiquita Brooks-LaS...
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With New Comment Period, CMS Will Reassess TennCare Cap

As the Biden administration continues to dash states’ dreams of implementing Medicaid work requirements — most recently revoking waiver approvals granted to Ohio, South Carolina and Utah by the Trump administrat...
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News Briefs

✦ Centene Corp. on Aug. 17 said the Ohio Dept. of Medicaid (ODM) made the long-awaited decision to renew its managed Medicaid contract with subsidiary Buckeye Health Plan. ODM in April named six other managed care...
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Expanded Medicare Benefits Could Drive Innovation in MA

Before the Senate adjourns for its annual summer recess, momentum was building at press time for what would be one of the most significant changes to the Medicare program since the addition of Part D. That would be ...
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SCAN Will Tackle Homelessness With New Medical Group

Sachin Jain, M.D., is a longtime champion of treating certain social factors as medical issues. In his work as president of CareMore Health, a physician-led care delivery subsidiary of Anthem, Inc., he spearheaded e...
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© 2024 MMIT