The Office of the Inspector General has released a report that raises questions about whether Medicare Advantage plans have inappropriately denied claims to increase profits.
Although it did not name specific plans, the OIG report is based on appeals to MA denials and the outcomes. MA organizations overturned 75 percent, amounting to 216,000 denials, from 2014 to 2016. Independent reviews at higher levels overturned an additional 80,000 denials during those two years in favor of the beneficiaries and providers, the report said.
Health insurer Anthem has refused to comply with the U.S. Justice Department's investigation into its Medicare Advantage billing practices, according to federal court documents filed Tuesday.
So the Justice Department this week asked the U.S. District Court for the Southern District of New York to force Anthem to comply with a civil investigative demand issued in March to provide testimony about its chart review and risk-adjustment program for its Medicare Advantage plans.
The Justice Department initially demanded the testimony by April 13 but said Anthem has yet...
CMS will not make $10.4 billion in payments that were due to insurers under the ACA.
Here's what you should know:
1. The payments were required under the ACA's "risk adjustment program" to offset costs for insurers whose customers need expensive medical services. They were due to insurers in the fall for expenses from 2017.
2. CMS Administrator Seema Verma said the suspension is based on a legal dispute over the formula used to calculate risk adjustment payments. About three years ago, a New Mexico federal court ruled the formula was flawed, but a Massachusetts judge...