Industry Alert: Iowa Senator Calls for Greater Scrutiny of MA Plans

Kaiser Health News recently published an article about Senator Chuck Grassley (R-Iowa) asking federal health officials to tighten scrutiny of private Medicare Advantage (MA) health plans. His request comes amid ongoing concern that insurers over-bill the government by billions of dollars every year.

In mid-April, Grassley wrote a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, citing an article that alleged billing discrepancies. He has asked CMS officials to explain why they failed to collect nearly $125 million in potential overcharges identified at five Medicare Advantage plans audited in a single year.

Grassley wrote, “…CMS must aggressively use the tools at its disposal to ensure that it is efficiently identifying fraud and subsequently implementing timely and fair remedies.” He also noted that CMS needs to increase oversight audits because MA plans are expected to grow substantially in coming years.

Our experts at Cody have been predicting for years that CMS will continue to crack down on health plans with increased oversight and audits. Don’t get caught unprepared. Cody can help your health plan through the following services:

  • CMS Audit Workshop – Learn what you need to know before receiving your audit letter, how to present data universes and tracer issues to CMS, what the audit experience entails, and more.
  • CPE Mock Audit
  • Full Program Mock Audit
  • On-site support for CMS audit preparation and response

For more information about how you can ensure you achieve compliance with industry and regulatory standards, please contact us today.