Low-quality Medicare Advantage plans should expect scrutiny, CMS says

Share this content:
CMS revises survey guidelines for some long-term care providers with Immediate Jeopardy citations
CMS revises survey guidelines for some long-term care providers with Immediate Jeopardy citations

Medicare Advantage plans with fewer than five stars on the quality scale should expect some form of audit, a Centers for Medicare & Medicaid official said this week.

CMS will look at best practices of five-star plans and release the results, while zeroing in on plans that are considered “highest risk,” said Jonathan Blum, CMS deputy administrator, in a Bureau of National Affairs report. Blum was speaking at the CMS 2012 Medicare Advantage & Prescription Drug Plan Spring Conference in Hunt Valley, MD.  Audio of the conference can be seen here.

The agency plans to conduct up to 40 MA audits this year, compared to 11 last year. It reflects an increased focus on audits by the agency, which include Recovery Audit Contractors looking at Medicare Part D, and Medicaid audits.

Medicare Advantage, or Medicare Part C, offers beneficiaries a number of different private managed care insurance options, such as hospital or skilled nursing care. It has recently come under scrutiny for overpayments.