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April 23, 2015

Recent Stories of Interest

From Medicare Advantage News - In the latest escalation of their longstanding feud, UPMC said this month it would terminate Medicare Advantage provider contracts with fellow Pittsburgh-based giant Highmark Health effective at the end of this year. The decision, which has drawn fire from Pennsylvania’s new governor as well as from some state regulators and legislators, stems from Highmark’s decision to reduce its payments for cancer care at UPMC facilities below levels specified in the two organizations’ longstanding contract. Highmark claims that the provider’s markups for services furnished in hospital outpatient clinics rather than physician offices were costing the insurer $200 million a year. Read more

While some health plans and states participating in the huge CMS-backed demonstration… Read more

A rising medical cost trend will wind up helping Medicare Advantage plans’… Read more

In an unusual alliance, hashed out over an 18-month period and marrying… Read more

From the Editor

Welcome to your Medicare Advantage News subscriber-only Web page

Be sure to visit often, for PDFs of issues, archives of articles, links to government documents and more!

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April 23, 2015
UPMC Letter to Pennsylvania Officials Defending Its Termination of Highmark MA Contracts

To view UPMC's April 2, 2015, letter to Pennsylvania officials defending its planned termination at the end of this year of Medicare Advantage provider contracts with Highmark Inc., click here

April 23, 2015
CMS's April 2015 Letter Imposing $1 Million CMP on Aetna

To view CMS's April 2, 2015, letter imposing a $1 million civil money penalty on Aetna Inc. because of inaccurate pharmacy-network listings, click here

April 15, 2015
SGR Repeal Easily Clears Senate

The doc-fix bill repealing the sustainable growth rate passed the Senate April 14 with little problem. http://tinyurl.com/najjz4h

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