News & Analysis as of

Medicare Part C Medicare Advantage

Health Care Compliance Association (HCCA)

Early returns on MA plans’ two-midnight rule interpretations: A compliance nightmare

The Centers for Medicare and Medicaid Services (CMS) issued regulations applicable to Medicare Advantage (MA) plans—also commonly referred to as managed Medicare or Part C Medicare—in April 2023 (CMS 4201–F) that address,...more

Foley & Lardner LLP

Medicare Overpayments: CMS Proposes Regulation Establishing Six Month Suspended Deadline for 60-Day Refund Rule

Foley & Lardner LLP on

The 60-day Refund Rule, created by the 2010 Affordable Care Act, requires providers to report and return Medicare and Medicaid overpayments within 60 days of identifying them. See Section 1128J(d) of the Social Security Act,...more

Ankura

OIG Testimony Puts a Spotlight on Clinical Documentation and Payer Risk

Ankura on

In recent testimony before the United States House Committee on Energy and Commerce Subcommittee on Oversight and Investigations, Christi A. Grimm, Inspector General of the Department of Health and Human Services (HHS)...more

Mintz - Health Care Viewpoints

CMS Publishes Final Rules Implementing Part C and Part D Program Changes

On April 23, 2024, the Centers for Medicare & Medicaid Services (CMS) published final rules setting forth Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Program for Contract Year 2024--Remaining...more

King & Spalding

CMS Finalizes Rule Regarding Marketing Changes, Beneficiary Protections, and Coverage for Medicare Parts C and D

King & Spalding on

On April 4, 2024, CMS published a final rule implementing certain policy changes to the Medicare Advantage (MA) Program (Medicare Part C) and the Medicare Prescription Drug Benefit Program (Medicare Part D). According to the...more

Sheppard Mullin Richter & Hampton LLP

CMS Issues CY2025 Medicare Advantage and Part D Final Rule

On April 4, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued the contract year 2025 (CY2025) Medicare Advantage and Part D final rule (the “Final Rule”). In addition to finalizing its CY2025 proposed rule,...more

Sheppard Mullin Richter & Hampton LLP

CMS Announces Medicare Advantage and Part D Rates for CY 2025

On April 1st, the Centers for Medicare & Medicaid Services (“CMS”) announced its Medicare Advantage (“MA”) Capitation Rates and Part C and Part D Payment Policies for Calendar Year (“CY”) 2025. This announcement builds on the...more

McDermott Will & Emery

340B Remedy Rule and Medicare Advantage Rates: Navigating Shifting Payments

McDermott Will & Emery on

On April 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, otherwise known as the...more

McDermott+

Another News-Filled Medicare Advantage Regulatory Week

McDermott+ on

Although I previously declared January 2024 Medicare Advantage (MA) Month, this week has also been filled with news about the MA program. The Centers for Medicare & Medicaid Services (CMS) released the final rate announcement...more

McDermott+

CMS Releases CY 2025 Rate Announcement for Medicare Advantage and Part D

McDermott+ on

On April 1, 2024, the US Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and D Payment Policies (Rate Announcement). CMS...more

King & Spalding

CMS Issues Transmittal Directing MACs to Implement New Part C Rule

King & Spalding on

On February 21, 2024, CMS published a transmittal on its website with instructions for Medicare Administrative Contractors (MACs) to implement CMS’s final rule, issued June 9, 2023, concerning the treatment of the Part C days...more

American Conference Institute (ACI)

[Event] 15th Annual Advanced Forum on Managed Care Disputes and Litigation - May 2nd - 3rd, Chicago, IL

ACI’s Advanced Forum on Managed Care Disputes and Litigation offers an unparalleled learning experience, specifically designed for the MCO legal community. Attend and develop winning legal strategies and business best...more

Goodwin

DOJ Renews Focus on Private Equity Amid Record False Claims Act Enforcement

Goodwin on

2023 was another record year for False Claims Act enforcement. On February 22, 2024, the U.S. Department of Justice (DOJ) announced that the federal government and whistleblowers were party to a record number of FCA...more

Holland & Knight LLP

CMS Previews Changes to Medicare Advantage Capitation Rates, Parts C and D Payment Policies

Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) released its Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies on Jan....more

WilmerHale

Criminal Indictment for Medicare Advantage Fraud

WilmerHale on

The U.S. Department of Justice (DOJ) recently announced a rare criminal indictment involving the Medicare Advantage program—a contrast from DOJ’s more typical use of its civil enforcement authority to pursue similar issues...more

King & Spalding

CMS Proposes Changes to the Medicare Advantage and Part D Programs Aimed at Improving Beneficiary Protections, Access to Care, and...

King & Spalding on

On November 6, 2023, CMS released a pre-publication version of a proposed rule (Proposed Rule) that is set to publish in the Federal Register on November 15, 2023, and that would amend the regulations governing Medicare...more

Epstein Becker & Green

Rare DOJ Criminal Indictment Related to Medicare Advantage Risk Adjustment

Epstein Becker & Green on

In an indictment announced on October 26, 2023 in Miami, the U.S. Department of Justice, Criminal Division’s Fraud Section, working with the FBI and HHS-OIG, brought what may be only the second federal criminal charges...more

The Volkov Law Group

Cigna Group Falls Under the False Claims Axe and Pays Over $172 Million for Abuse of Medicare Advantage Program

The Volkov Law Group on

As if corporate healthcare businesses needed an enforcement reminder, DOJ recently announced a settlement with Cigna Group for $172 million to resolve claims that Cigna exaggerated patient illnesses to extract more money from...more

American Conference Institute (ACI)

[Event] 2nd Annual Legal, Regulatory and Compliance Summit on Medicare Advantage - November 2nd - 3rd, Nashville, TN

Hosted by American Conference Institute, the 2nd Annual Legal, Regulatory and Compliance Summit on Medicare Advantage returns for another exciting year with curated programming that will address the latest oversight and...more

Bass, Berry & Sims PLC

Martin’s Point Health Care Inc.’s $22.4M Settlement Illustrates DOJ’s Focus on Part C Fraud

Bass, Berry & Sims PLC on

Last week, the U.S. Department of Justice (DOJ) announced a $22.4 million settlement resolving allegations that Martin’s Point Health Care, Inc. (Martin’s Point) violated the False Claims Act (FCA) by submitting inaccurate...more

Epstein Becker & Green

CMS Forwards Its Health Equity Agenda through Its Annual Prospective Payment System Rulemaking Process

The Centers for Medicare & Medicaid Services (“CMS”) is using its annual rulemaking process to update the CMS payment system rules for fiscal year (“FY”) 2024 as a mechanism to advance health equity systematically across...more

Proskauer - Health Care Law Brief

2024 Final Rule: CMS Announces More Changes to Medicare Advantage but Declines to Reform the “60 Day Rule”

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. Parts 417, 422, 423,...more

Groom Law Group, Chartered

CMS Charts the Future of Medicare Advantage and Part D in 2024

CMS published the Calendar Year (“CY”) 2024 Medicare Advantage (“MA”) Capitation Rates and Part C and Part D Payment Policies (“Rate Announcement“) on March 31 and, five days later, issued the MA and Part D final rule for...more

McDermott Will & Emery

CMS Finalizes Risk Adjustment Model in 2024 Rate Announcement for Medicare Advantage and Part D

On March 31, 2023, the US Centers for Medicare & Medicaid Services (CMS) issued its Announcement of Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, otherwise known as...more

Proskauer - Health Care Law Brief

Medicare Advantage 2024 Rate Announcement – Further Impacts to Risk Adjustment

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Rate Announcement). This Rate...more

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