Our federal government has always allowed people with Medicare to enroll in poor performing Medicare Advantage plans–ones that deny care inappropriately or delay it needlessly, endangering the lives of their enrollees. What’s worse is that Medicare does not disclose which Medicare Advantage plans are poor performing. The star ratings are terribly misleading. Here’s some possibly good news: The Centers for Medicare and Medicaid Services, which oversees Medicare, now has the authority to boot poor-performing Medicare Advantage plans out of the program, reports Kristin Kushno for Becker’s.
The open question is whether CMS will use this authority and boot the bad actors out of Medicare Advantage in the interest of enrollees? The HHS Office of the Inspector General still holds this authority. But, it rarely if ever uses it to boot insurers engaged in bad acts from Medicare Advantage.
It’s not clear why CMS has not had this authority before. How could it be that entities contracting with CMS could engage in fraud, abuse, waste and other contractual and legal violations without meaningful punishment? How could it be that CMS could allow people with Medicare and Medicaid to enroll in Medicare Advantage plans that are doing harm to enrollees or the Medicare program?
The new CMS authority was published in the Federal Register on Oct. 14. It gives the HHS secretary this authority under Section 1128(b) of the Social Security Act.
Here’s more from Just Care:
- Medicare ratings of Medicare Advantage plans a farce
- OIG finds widespread inappropriate care denials in Medicare Advantage
- Medicare Advantage insurers face few penalties for their bad acts
- Medicare Advantage needs an overhaul
- OIG finds Medicare Advantage continues to overcharge government
