In the News

Medicare Advantage star-rating policy shift

Modern Healthcare reported that CMS shocked the industry by scrapping plans to lower star ratings for Medicare Advantage plans facing sanctions for poor compliance. The change will protect up to $350 Milion for Cigna Corp which received sanctions in January. Previously policy stated that any Medicare Advantage plan that faced “intermediate sanctions” would have its quality rating dropped to 2.5 stars or, if their rating... Read More

Medicare Advantage Part D Fines Less in 2015

Modern Healthcare recently reported that civil monetary penalties issued to insurers offering private Medicare were down over 4% in 2015 compared with the prior year. These fines, issued for noncompliance with Medicare’s coverage rules, totaled $4.72M last year, and while the jury is still out, most experts believe that the decline is primarily due to plans getting better at interpreting the rules. “Richard Lieberman, chief... Read More

2016 Star Ratings Released

Modern Healthcare reported on the pending release of CMS 2016 star ratings for Medicare Advantage plans. “The industry complains, but despite all the rhetoric, they’re actually responding,” said Richard Lieberman, chief data scientist at Mile High Healthcare Analytics. “Plans are getting savvy at managing those process measures. By contrast, low-performing plans are struggling with member experience measures—those that gauge whether enrollees are happy with their doctors... Read More