Medicare Advantage and Part D

Federal Agents Raid Universal’s Offices in Apparent Fraud ProbeFederal Agents Raid Universal’s Offices in Apparent Fraud Probe

From Medicare Advantage News - The problems for Universal Health Care Group Inc. and its former executives deepened yet again when federal agents raided its St. Petersburg, Fla., headquarters March 28 as part of an apparent health care fraud investigation. The agents from the FBI and a federal task force, bearing search warrants but not disclosing what they were looking for, ushered all but a few employees out of the building and then removed files from storage cabinets and examined computers. Read more

More Providers Seek to Own MA Plans, as Comfort With Risk Trumps Bad MemoriesMore Providers Seek to Own MA Plans, as Comfort With Risk Trumps Bad Memories

From Medicare Advantage News - While it is hardly a major trend yet, and it may pale next to other new developments involving provider organizations, there is clear evidence that growing numbers of provider groups have decided within the past year that they want to buy or start Medicare Advantage plans. The new moves stem partly from the increasing desire of numerous provider organizations to assume risk so that they have the potential for greater financial… Read more

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From One Extreme to the Other: CBO's MA Projections
By James Gutman - May 21, 2013
It seems that everybody has a theory as to why the Congressional Budget Office (CBO), which in 2010 forecast a drastic decline in Medicare Advantage enrollment stemming largely from provisions of the health reform law, on May 14 issued new projections saying that MA enrollment — and payments to MA...
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CMS Fine-tunes MA Plan Audit Methodology — and Is Transparent About It
By James Gutman - May 10, 2013
CMS seems to be taking its own advice when it comes to continuous quality improvement — at least in the program audits of Medicare Advantage plans. As outlined by agency speakers at the CMS MA and Part D spring conference May 6, there has been an overhaul of the methodology used in the audits...
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How to Weaken a Good CMS MA/Part D Conference
By James Gutman - May 6, 2013
There probably was no good way for CMS to deal with its annual spring Medicare Advantage and Part D conference in light of sequestration-related budget cuts and furloughs. What has been in previous years an in-person (as well as webcast) conference with no registration fee could not be cost-...
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