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Healthcare › Medicare › Medicare Advantage Organizations (MAOs)

Manatt, Phelps & Phillips, LLP

HHS OIG Scrutinizes Medicare Advantage Use of Health Risk Assessments

Manatt, Phelps & Phillips, LLP on

On October 24, the HHS Office of Inspector General (OIG) released a report titled “Medicare Advantage: Questionable Use of Health Risk Assessments Continues to Drive Up Payments to Plans by Billions.” In evaluating 2022 MA...more

Arnall Golden Gregory LLP

OIG Issues Unfavorable Opinion on MAO’s Proposed Gainshare Program

Arnall Golden Gregory LLP on

The Department of Health and Human Services, Office of Inspector General (“OIG”) recently released an unfavorable advisory opinion, OIG Advisory Opinion No. 24-08 (the “Opinion”), to a Medicare Advantage Organization (“MAO”)....more

Bass, Berry & Sims PLC

More Losses than Gains? OIG Declines to Approve Certain Medicare Advantage Gainsharing Arrangements in Advisory Opinion 24-08

Bass, Berry & Sims PLC on

On September 13, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published Advisory Opinion 24-08, in which it declined to approve a proposal by a Medicare Advantage organization (MAO)...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

McDermott+

CMS Releases CY 2025 Advance Notice for Medicare Advantage and Part D

McDermott+ on

On January 31, 2024, the US Centers for Medicare & Medicaid Services (CMS) released the Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and D...more

Groom Law Group, Chartered

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

Groom Law Group, Chartered on

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

Groom Law Group, Chartered

CMS Medicare Advantage RADV Final Rule: No Fee-For-Service Adjuster, May Extrapolate Audit Findings Beginning with PY 2018

Groom Law Group, Chartered on

More than four years after it was proposed, on February 1, 2023 the Centers for Medicare & Medicaid Services (CMS) published the long-awaited risk adjustment data validation (RADV) Final Rule (Final Rule) that will affect...more

Nelson Mullins Riley & Scarborough LLP

The RADV Final Rule and Advance Notice of CY 2024 Capitation Rates: Provider Considerations

Nelson Mullins Riley & Scarborough LLP on

The Centers for Medicare & Medicaid Services (CMS) was very busy last week! On Jan. 30, CMS issued its long-awaited Risk Adjustment Data Validation (RADV) Final Rule....more

Ballard Spahr LLP

CMS Releases Final Rule for Risk Adjustment Data Validation Audit Methodology

Ballard Spahr LLP on

On January 30, 2023, CMS posted for inspection a final rule describing its Risk Adjustment Data Validation audit methodology (the Final RADV Rule). As we have discussed in prior alerts, the finalization of the RADV Rule,...more

Groom Law Group, Chartered

CMS Proposed Rule Would Leverage Technology and Interoperability to Improve Prior Authorization

Groom Law Group, Chartered on

On Tuesday, December 13, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“New Proposed Rule”) to improve the prior authorization process and advance interoperability for Medicare Advantage...more

Proskauer Rose LLP

HHS OIG Adopts NewAnti-Kickback Safe Harbor and Civil Monetary Penalty Exceptions

Proskauer Rose LLP on

On December 7, 2016, the Department of Health and Human Services (HHS), Office of Inspector General (OIG), issued a final rule that will have a widespread impact on health care service providers, medical transport providers,...more

Pierce Atwood LLP

CMS Continues Efforts to Improve Patient Care, Spending, and Population Health

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On November 2, 2016, the Centers for Medicare and Medicaid Services (CMS), released the 2017 Medicare Physician Fee Schedule (MPFS) final rule, which finalized a number of new policies designed to improve Medicare payment for...more

Akerman LLP - Health Law Rx

11th Circuit Awards Humana Double Damages Under Medicare Secondary Payer Act

Akerman LLP - Health Law Rx on

Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436. Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights...more

Carlton Fields

Medicare Advantage Organizations May Sue For Double Damages Under MSP Act - Humana Medical Plan, Inc. v. Western Heritage Ins....

Carlton Fields on

On August 8, the Eleventh Circuit Court of Appeals decided an issue of first impression in the circuit under the Medicare Secondary Payer (MSP) Act. In sum, the Eleventh Circuit held that a Medicare Advantage Organization...more

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