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
From Medicare Advantage News - It did not take long in 2015 for the first new Part D battle to erupt between a major insurer and a large trade group for independent retail pharmacies. The 23,000-member National Community Pharmacists Association (NCPA) on Jan. 7 rebuked Aetna Inc. for listing on the company’s websites and the CMS Medicare Plan Finder as in-network for 2015 numerous pharmacies that turned out not to be in most cases. Since… Read more
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