Medicare Advantage and Part D

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

Medicare Advantage & Part D Blog

By James Gutman - December 4, 2014
It has become a new year-end custom: reading every line of CMS’s annual proposed Medicare Advantage (MA) and stand-alone Prescription Drug Plan star ratings enhancement memo and trying to figure out what the agency actually will wind up doing. And this year’s memo, dated Nov. 21, figures to be no...
By James Gutman - November 19, 2014
The Medicare Payment Advisory Commission may not be as influential these days as its creators envisioned, especially since the Congress it advises doesn’t even listen to its own members, let alone an outside body, but MedPAC’s meetings continue to have an entertainment value on their own. And this...
By James Gutman - November 6, 2014
Provider systems, which often in years past made clear they wanted as little as possible to do with Medicare Advantage (MA), clearly have changed their minds. The 2015 lineup of MA plans now being marketed in the Annual Election Period (AEP) includes a host of new MA plans either in which the...

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