Radar on Medicare Advantage

  • News Briefs: Cigna Agrees to Pay $172.3M to Resolve False Claims Act Allegations

    Resolving longstanding legal issues regarding its Medicare risk adjustment submissions, The Cigna Group has agreed to pay nearly $172.3 million and enter into a Corporate Integrity Agreement with the HHS Office of Inspector General. Cigna will pay approximately $135.3 million to resolve allegations stemming from an investigation based out of the Eastern District of Pennsylvania, according to a Sept. 30 press release from the U.S. Attorney’s Office. The insurer was accused of using a “chart review” program operated to identify and submit inaccurate diagnosis information in order to receive higher risk-adjusted payments from CMS while failing to delete or withdraw the “inaccurate or untruthful” diagnosis codes. The remaining $37 million will resolve allegations related to unsupported diagnoses for MA beneficiaries arising from Cigna’s home visit program. The allegations were brought in a whistleblower lawsuit transferred from the Southern District of New York, said the U.S. Attorney’s Office. Cigna in its own press release said the agreements “fully resolve” the False Claims Act lawsuit and investigation and will allow it to “maximize the company’s focus on delivering value to customers and taxpayers.” Cigna did not admit wrongdoing as part of the settlement.
  • Reports of Cold Calling, False Promises Put Medicare Marketers on Alert

    As Medicare Advantage insurers prepare for the Oct. 1 start of Annual Election Period (AEP) marketing, they face an increased level of scrutiny as CMS implements various provisions aimed at curbing misleading and aggressive marketing practices. But new research suggests that some of the marketing misconduct of years past could rear its ugly head again this fall, prompting industry experts to question whether CMS should take additional steps or if action from Congress is needed.

    Released on Sept. 12, the Commonwealth Fund’s survey of seniors’ experiences during the last week of the 2023 AEP tells the familiar tale of Medicare beneficiaries inundated with marketing messages during open enrollment. Nearly all seniors saw or received some form of plan marketing — ranging from phone calls to television advertisements — and more than three-quarters reported seeing television or online ads once daily. Additionally, 73% received phone calls at least once a week, and 30% reported receiving at least seven calls in a week. And despite CMS rules barring marketers from calling beneficiaries unless they’ve agreed to be contacted or requested the call, 74% of all respondents reported receiving an unsolicited call from a plan or plan representative.

  • Alignment Health: Seniors’ Top Social Barriers to Health Offer Benefit Design Opportunities

    Economic instability, food insecurity, limited access to transportation and overall lack of support are seniors’ top barriers to staying healthy, according to new data from Alignment Health. Sponsored by the tech-enabled Medicare Advantage insurer, the second-annual Social Threats to Aging Well in America survey polled 2,601 seniors across Alignment’s six-state service area, asking them about their financial, physical and emotional needs — and how those needs are impacting their health. Their responses illuminate the types of supplemental benefits that could prove most valuable to seniors weighing their coverage options as the 2024 Annual Election Period approaches.

    Not having enough money for medical expenses was the most common overall obstacle to health, reported by 41% of survey respondents who anticipate any upcoming challenges. And about 20% of respondents cited financial instability as their top obstacle to health and wellness. One in 5 seniors said they’ve skipped out on needed medical care, and lack of funds was the No. 1 reason for doing so. In addition, 14% of seniors said they have outstanding medical debt, and 11% do not think they will be able to pay all of their medical bills in the coming year. When asked about supplemental benefits, nearly half (46%) of respondents said they would take advantage of assistance with rent, mortgage payments, and/or utility bills. Seniors also responded positively to fuel and grocery allowances.

  • Troubled by Too Many Plan Options, MedPAC Agrees to Pursue MA Benefits Standardization

    To help overwhelmed seniors make better Medicare Advantage plan comparisons, the Medicare Payment Advisory Commission (MedPAC) nearly a year ago began discussing the concept of standardizing a limited number of common supplemental benefits in MA. During its September public meeting, MedPAC agreed to devote a chapter of its June 2024 report to standardizing select MA benefits, while several commissioners echoed previous sentiments about striking a balance between standardization and flexibility.

    At its November 2022 public meeting, the independent congressional agency considered two different approaches: (1) standardizing a limited number of common supplemental benefits, such as dental, hearing and vision, and (2) standardizing Medicare Parts A and B services, whereby plans use a limited number of benefit packages. But some commissioners at the time expressed concern about potentially hampering MA plan innovation.

  • MedPAC Processes Headache-Inducing Alternatives for Estimating MA Coding Intensity

    As the Medicare Payment Advisory Commission (MedPAC) continues to consider ways Congress could achieve greater parity between traditional, fee-for-service (FFS) Medicare and Medicare Advantage, its September public meeting touched on several program aspects that are ripe for change. Three such areas — MA benefit standardization, access and quality, and encounter data — are slated to be addressed in separate chapters of its June 2024 report, MedPAC confirmed. Meanwhile, an analytical discussion on alternative methods of assessing MA coding intensity could lead the commission to conclude that MA plans are overpaid by even more than its current estimates, which are already disputed by the industry’s largest trade group.
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