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February 26, 2015

Recent Stories of Interest

From Medicare Advantage News - The big news in CMS’s release late Feb. 6 of its long-awaited final Medicare Advantage and Part D rule was in the several major Part D provisions it had proposed more than a year ago (MAN 1/9/14, p. 1) that it again decided not to finalize. These controversial items, as listed in a CMS Fact Sheet accompanying the new rule, include provisions that would have limited the growth of preferred pharmacy networks, reduced the number of Part D plans a sponsor may offer and lifted the protected-class designation on three major classes of drugs in an effort to control costs. Read more

Publicly held Medicare Advantage insurers generally ended 2014 on a high note,… Read more

There are many qualifiers that limit what trends are clear in the… Read more

From a rule awaiting final clearance that’s likely to mean big changes… 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.

February 26, 2015
Indictment of Capitated Florida Physician for Alleged Medicare Advantage Upcoding

To view the indictment by a Florida grand jury of former capitated Humana Inc. network physician Isaac Thompson, M.D., for alleged upcoding of diagnoses in Medicare Advantage, click here

February 26, 2015
CMS Fact Sheet on 2016 '45-Day Notice' and MA and Part D Call Letter

To view CMS's Feb. 20, 2015, Fact Sheet on the 2016 advance Medicare Advantage payment notice and MA and Part D Call Letter, click here

February 12, 2015
CMS's Nov. 5, 2014, Memo on Reporting Pharmacy Price Concessions

To view the Nov. 5, 2014, memo from CMS outlining new requirements for Part D sponsors beginning for contract year 2016 in reporting pharmacy price concessions, click here

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