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November 20, 2014

Recent Stories of Interest

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 of inpatient care in Medicare and Medicaid. Read more

Just how difficult it is to have a smooth launch of a… Read more

There has been a marked change in tone in the comments of… Read more

Medicare-Medicaid dual eligibles fared significantly worse than non-duals on a majority of… 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!

Please e-mail me with your comments on the last issue of Medicare Advantage News, story ideas for future issues, or any other suggestions you have that can make the newsletter more useful for you.

November 20, 2014
Newly Unsealed Whistleblower Suit Against WellCare

To view the newly unsealed whistleblower suit against WellCare Health Plans, Inc. related to coverage denials for inpatient care, click here

November 20, 2014
Presentation at Medicare Advantage session of November 2014 MedPAC meeting

To view the staff presentation on Medicare Advantage margins at the Nov. 6, 2014, meeting of the Medicare Payment Advisory Commission, click here

November 6, 2014
Mulcahy August 2014 Memo on Top Five MA and PDP Problems in Program Audits

To view the August 2014 memo from Gerard Mulcahy, director of CMS's Medicare Parts C & D Oversight and Enforcement Group, on the top five problems found in each MA and Part D program audit area in 2013, click here

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