News Briefs

September 17

✦ The overall average scores for Medicare Advantage and Part D organizations subjected to 2019 program audits dropped from 1.03 in 2018 to 0.77, according to the 2019 Part C and Part D Program Audit and Enforcement Report. Published on Sept. 14, the same day as the early release of Part 1 of the Advance Notice (see story, p. 1), the Medicare Parts C and D Oversight and Enforcement Group (MOEG) estimated that CMS imposed a total of $1.6 million in civil monetary penalties on eight sponsors in 2019. That was the first year of the third audit and covered approximately 71% of MA and Part D enrollees. Compared with the 2018 program audits, sponsors showed the greatest improvements in the areas of Compliance Program Effectiveness and Medicare-Medicaid Plan Service Authorization Requests, Appeals and Grievances. The average number of conditions cited per audit in 2019 was 11, compared with 38 in 2012, observed MOEG. Visit https://go.cms.gov/2GXhPyN.

✦ Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) has partnered with health system Hackensack Meridian Health to offer a Medicare Advantage plan for 2021. The jointly operated plan, Braven Health, will also feature RWJBarnabas Health, subject to approval by the New Jersey Dept. of Banking and Insurance. It will offer MA plans in eight New Jersey counties with a “broad provider network anchored by Hackensack Meridian Health and that includes all health care professionals who participate in Horizon BCBSNJ’s managed care network,” according to a Sept. 14 press release. Visit www.bravenhealth.com.

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Radar on Medicare Advantage

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.