From Medicare Advantage News - Just when it looked as if WellCare Health Plans, Inc. finally had emerged from its longstanding legal problems, it turned out that the company is enmeshed in a big new whistleblower lawsuit. In the complaint, originally filed in May 2013 in U.S. District Court in Tampa, Fla., but not unsealed until the end of last month, six former professional staff members of the insurer — including its former vice president of care management — sued the company under the False Claims Act, alleging they were fired because they resisted pressure from senior executives to boost the denial rate for coverage… Read more
From Medicare Advantage News - There is no direct correlation between CMS star quality ratings that a Medicare Advantage plan receives and the actual performance of that plan in the agency’s MA program audits, according to the new annual audit and enforcement report for the MA and Part D programs released by CMS’s Medicare Parts C & D Oversight and Enforcement Group (MOEG). Read more
From Medicare Advantage News - The longstanding conflict between western Pennsylvania giants Highmark Inc. and UPMC erupted anew this month, with the battleground being a new Medicare Advantage product Highmark is introducing for 2015. Within days after Highmark’s Oct. 1 unveiling of the narrow-network MA plan, which excludes UPMC providers along with some other area health systems, Pennsylvania went to court, claiming the product violates this summer’s consent decree that was supposed to end the Highmark-UPMC… Read more
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