Suzanne York

The Office of the Inspector General of the Department of Health and Human Services has issued a report entitled “Some Medicare Advantage Companies Leveraged Chart Reviews and Health Risk Assessments to Disproportionately Drive Payments.” The OIG undertook the review due to concerns that Medicare Advantage (MA) plans “may leverage both chart reviews and Health Risk …

OIG ISSUES REPORT FINDING THAT SOME MEDICARE ADVANTAGE COMPANIES USED CHART REVIEWS AND HEALTH RISK ASSESSMENTS TO DISPROPORTIONATELY INCREASE RISK ADJUSTMENT PAYMENTS Read More »

The Department of Health and Humana Services Office of the Inspector General has issued a report estimating that the Medicare program made $2.6 billion in risk adjustment payments to Medicare Advantage organizations (“MAOS”) in 2017 based solely on diagnoses reported in Health Risk Assessments (“HRAs”). The OIG further found that 80% of the estimated payments …

OIG REPORT RAISES CONCERNS ABOUT MEDICARE’S PAYMENT OF BILLIONS IN RISK ADJUSTMENT PAYMENTS TO MEDICARE ADVANTAGE PLANS Read More »

On March 28, 2019, Judge John D. Bates, of the United States District Court for the District of Columbia struck down the Trump Administration’s Association Health Plan (AHP) Final Rule. The AHP Final Rule had been designed to allow small employers and individuals to join together to purchase health plans that would be less expensive …

FEDERAL COURT STRIKES DOWN ASSOCIATION HEALTH PLAN RULES Read More »