Radar on Medicare Advantage

Risk Adjustment, UM Practices Would Be Likely Targets if Lawmakers Pursue MA

  • Jan 04
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    Jan 04, 2024

    With the recent filing of two proposed class action lawsuits against major Medicare Advantage insurers’ use of a computer algorithm to deny patient care, upcoming CMS audits of MA plans’ utilization management (UM) tactics and progressive lawmakers’ push for CMS to collect more data on coverage denials, the MA program is starting the year off under a microscope. And while major new policy developments are unlikely to come out of a split Congress this year, industry experts agree that prior authorization — along with risk adjustment and coding intensity — will continue to garner attention from lawmakers and regulators.

    HealthScape Advisors Principal Cary Badger and Managing Director Alexis Seeder Levy point to three possible regulatory scenarios to watch for in 2024:  

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    • Lauren Flynn Kelly

    Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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Meet Our Reporters

Lauren Flynn Kelly

Executive Editor, AIS Health, and Managing Editor, Radar on Medicare Advantage

View Lauren Flynn Kelly's Profile

Angela Maas

Managing Editor, Radar on Specialty Pharmacy and Spotlight on Market Access

View Angela Maas's Profile

Leslie Small

Managing Editor, Health Plan Weekly and Radar on Drug Benefits

View Leslie Small's Profile

Tim Casey

Reporter, Health Plan Weekly and Radar on Drug Benefits

View Tim Casey’s Profile

Carina Belles

Reporter, Radar on Medicare Advantage and Spotlight on Market Access

View Carina Belles's Profile

Jinghong Chen

Reporter, Health Plan Weekly and Radar on Drug Benefits

View Jinghong Chen's Profile

Jill Drachenberg

Reporter, Health Plan Weekly and Radar on Drug Benefits

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Legislation & Regulation
Risk Adjustment
Fee-for-Service Medicare
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