From Medicare Advantage News - The disappointments that Universal American Corp. has experienced with its vaunted 2012 acquisition of APS Healthcare — which was intended to enable Universal to get a base in Medicaid managed care — hit the courts Oct. 22. Universal sued affiliates of the GTCR private-equity firm it bought APS from, a managing director at GTCR and the former top managers of APS on a host of charges including securities fraud, common-law fraud, breach of contract and conspiracy to commit fraud. Among the remedies Universal seeks in the suit filed in U.S. Read more
From Health Plan Week - Some publicly traded Medicare Advantage (MA) plans are separating themselves from the pack by improving their CMS star scores. In fact, the 2014 quality rankings put insurers like Health Net, Inc., Cigna Corp. (through its HealthSpring subsidiary), UnitedHealth Group and Aetna Inc. in the position to benefit when payments occur in 2015, market consultants tell HPW. Carriers have invested in staffing, improved analytics and closer collaboration with provider networks to… Read more
From Medicare Advantage News - The long-delayed start of the Medicare Advantage Recovery Audit Contractor (RAC) program mandated in the Affordable Care Act finally may be approaching. And based on issues arising in the already underway Medicare Part D RAC audits called for in the same law — plus others stemming from the fundamentally prospective nature of MA (Part C) payments that complicate the ability to determine overpayments — it could be difficult for plans… Read more
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