Recent updates on Medicare Advantage include the New York City Mayor overriding attempts to block Aetna’s contract, proposals to curb misleading marketing, Aetna seeking intervention in a retirees’ lawsuit, research suggesting higher overpayments than previously estimated, Keystone Health Plan East receiving $11.3 million in overpayments, audits finding $32 million in overpayments across six plans, and a study showing the benefits of in-home health visits for Medicare Advantage patients.
Medicare Advantage has been making headlines lately with several noteworthy updates. Here are seven important updates reported by Becker since June 8.
1. New York City Mayor Overrides Comptroller’s Attempt to Block Aetna Contract:
Mayor Eric Adams has overridden City Comptroller Brad Lander’s attempt to halt the implementation of a contract between New York City and Aetna. The contract aims to administer a Medicare Advantage plan for 250,000 retired city employees, despite an ongoing lawsuit challenging the plan.
2. Alliance of Community Health Plans Proposes Policies Against Misleading Marketing:
The Alliance of Community Health Plans has put forth a series of policy proposals to combat misleading marketing practices in Medicare Advantage.
3. Aetna Seeks Intervention in Retirees’ Lawsuit:
Aetna is seeking to intervene in a lawsuit filed by retired New York City employees who are trying to block the implementation of Aetna’s Medicare Advantage contract with the city. In its petition, Aetna refutes the retirees’ allegations and denies that their Medicare Advantage plan would lead to coverage denials, higher costs, or more restricted networks.
4. New Research Highlights Potential Medicare Advantage Overpayments:
Researchers from the University of Southern California in Los Angeles have published a whitepaper indicating that Medicare Advantage plans enrollees have lower expenses compared to similar risk score individuals in traditional Medicare. However, payments to the program are based on traditional Medicare, suggesting that overpayments in Medicare Advantage could be more significant than previously estimated.
5. Keystone Health Plan East Overpaid by $11.3 Million:
An audit conducted by the Office of Inspector General (OIG) revealed that Independence Blue Cross’ Keystone Health Plan East received an estimated $11.3 million in overpayments for the years 2016 and 2017.
6.OIG Reports $32 Million in Overpayments Across Six Medicare Advantage Plans:
According to the OIG’s semiannual report to Congress, audits conducted in the past six months discovered approximately $32 million in overpayments across six different Medicare Advantage plans.
7. Study Shows Benefits of Optum HouseCalls Program for Medicare Advantage Patients:
A study conducted by researchers from Yale Medicine and Optum reveals that Medicare Advantage patients who receive in-home health visits through the Optum HouseCalls program spend less time in emergency rooms and inpatient hospital settings.
These recent updates shed light on various aspects of Medicare Advantage, including legal battles, overpayments, marketing concerns, and positive outcomes for patients.