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June 15, 2017

Today's Featured Story

More Formularies May Mean More Problems on Audits, Suggests CMS

CMS’s annual report summarizing activities for the prior audit year — released several months earlier than usual — contained some “encouraging” results, such as improved performance in the Part D program areas of Formulary and Benefit Administration (FA) and Coverage Determinations, Appeals, and Grievances (CDAG), observed a CMS official who spoke during a session of the Medicare Advantage and Prescription Drug Plan Audit and Enforcement Conference. However, the report showed that plan sponsors continued to be cited for the same mistakes, particularly in Part D, and suggested a correlation between the number of formularies a sponsor operates and its audit score, observed Greg McDonald with the Division of Analysis, Policy and Strategy in the Medicare Parts C & D Oversight and Enforcement Group.... Read Full Story

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Today's AIS Health Datapoint

345,100 ... is the number of enrollees in Kaiser Permanente Senior Advantage (HMO), the nation’s largest Medicare Advantage plan. With over 3,000 Medicare plans in the U.S., it accounts for 2% of enrollment nationwide.



People on the Move

Healthx, Inc. named Jim Meer chief financial officer and Ellen Humphrey chief people officer. Prior to joining Healthx, Meer was senior vice president of finance at Appirio. Humphrey previously was senior vice president, human resources for Appirio….Peerfit appointed Adam Lowe chief technology officer. He most recently was chief technology officer for Aetna Inc. subsidiary WellMatch….Cigna Corp. hired Dr. Catherine Dimou as market medical executive for the company’s Midwest Market (covering Illinois, Indiana, Wisconsin, Minnesota and Michigan). Dimou joins Cigna from Rush University Medical Center, where she held multiple senior leadership positions, most recently associate dean of medical services.


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