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OIG report cites widespread MAO problems related to denials of care and payment. Medicare and Medicaid are moving steadily into a capitated model system – or should I say, “have moved.” A central concern about the capitated payment model used in Medicare Advantage is the financial incentive for Medicare Advantage…
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Many MAOs have overplayed the significance of this decision. On Sept. 7, in federal district court in Washington, D.C., in a case in which the Medicare Advantage Organizations (MAOs) in the UnitedHealth Group family of companies sued Alex Azar, the Secretary for the U.S. Department of Health and Human Services…
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Medicare Advantage (MA) programs continue to gain popularity, with about one-third of Medicare beneficiaries currently enrolled in a variety of MA programs. MA plans are issued by MAOs, or Medicare Advantage Organizations, that are typically insurance companies. Medicare beneficiaries are attracted to these programs because they offer increased coverage for…
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The American College of Physician Advisors (ACPA) has responded to a Centers for Medicare & Medicaid Services (CMS) request for recommendations for improvements to the Medicare Advantage program with a detailed position paper outlining a wide variety of proposed changes. In an April 24 letter to U.S. Secretary of Health…
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The second of two recent lawsuits against Medicare Advantage Organizations (MAOs) was announced on Tuesday, when the U.S. Department of Justice reported a $32.5 million settlement with Freedom Health Inc. and Optimum Healthcare, MAOs based in Tampa, Fla. The reported settlement resolves allegations that the insurers violated the False Claims…