Medicare Advantage and Part D

From Medicare Advantage News - In the first criminal case the U.S. Attorney’s Office in South Florida has brought on alleged fraud via up-coding of Medicare Advantage diagnoses, the feds this month obtained a grand-jury indictment against a Palm Beach County physician accused of causing at least $2.11 million in excessive MA payments. At the time, Isaac Kojo Anakwah Thompson, M.D., was a capitated member of Humana Inc.’s MA provider network, but he no longer is in the network, says the company, which is not accused of wrongdoing in the indictment and contends it has repaid money as part of cooperating with the feds on… Read more

From Medicare Advantage News - Nearly half of the entities now operating Medicare Advantage plans are provider-sponsored, and that figure is likely to keep rising, according to a speaker at a Jan. 21 AIS webinar on narrow-network MA plans. But Gary Jacobs, managing director in the Health Industries Advisory practice at PricewaterhouseCoopers and a former top executive at MA insurer Universal American Corp., also said that providers intent on entering MA will need “new competencies”… Read more

Medicare Advantage & Part D Blog

By James Gutman - March 18, 2015
It seems to happen every year, and 2015 looks like no exception. From the time CMS releases in late February its draft Medicare Advantage plan payment notice and MA and Part D Call Letter for the following year, and until the final document comes out the first Monday in April, there’s a battle of...
By James Gutman - March 4, 2015
It has become sort of a game in recent years predicting what adjustments will appear on Medicare Advantage payment rates in the “45-day notice” and final notice in order for CMS to get to where it wants — and the laws require — on the rates for the following year. And while consultants and...
By James Gutman - February 18, 2015
The full picture of how the 2015 Annual Election Period (AEP) was for Medicare Advantage (MA) plans finally emerged Feb. 11 when CMS posted the February enrollment data, and the answers in two words are “good” and “perplexing.” The “good” stems from an approximately 342,000 gain in MA membership...

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