NY Times article reiterates compliance trends in Medicare Advantage

As many of you have already read, the NY Times ran a scathing article on October 12th titled “U.S. Finds Many Errors in Medicare Health Plans” shining a light on serious Compliance issues we’ve all been aware of over the past several years. Is the continued lack of non-compliance really news to anyone in the industry? Most certainly not — we have all been tracking the continued issues of non-compliance, increased CMS Compliance actions, and have read the audit reports posted on the CMS website. What the NY Times article did was remind us that the compliance trends in Medicare Advantage are a serious matter which should not be taken lightly.

The fact is, Medicare beneficiaries have not had access to their care; both Medical care and Prescription drugs.This is simply not acceptable — period. That being said, I have personally worked on the Plan side, on the consulting side, and as a CMS sub-contractor, and I know, firsthand,  the challenges we face in the implementation of the thousands of Compliance requirements. This is no easy task, and anyone who thinks it is, simply doesn’t understand plan operations. By and large, what we find is that Organizations want to be compliant; but they don’t have the tools or resources to implement and manage this highly regulated program. So, what do you do next? Here is what we recommend:

• If you haven’t done so already, go through the exercise of a Mock CMS audit – find your deficiencies now, both for the sake of the beneficiary, and for the sake of your CMS contract.
• Focus first on those issues that have the most beneficiary impact — ensure that your members have access to care as your number one priority.
• Document your remediation efforts and measure outcomes — issues aren’t resolved overnight, but ensuring that your remediation plan is working is the key to success.

If you’re not sure where to start, we can help. Please find here a description of our Mock CMS Audit Service, or contact us directly.

Resources

On Friday, Sept, 12 a GHG team member provided GHG’s perspective on trends relating to CMPs, the CMS audit findings and oversight activities that have taken place in the last six to 12 months, as well as tips on how to avoid and remediate CMS findings. Become a member of the Point to access the webinar recording >>

All Medicare Advantage and Prescription Drug Plans must ensure that they are audit-ready all the time so that each CMS audit is routine.  Save the fire drills for fires, and receive standing ovations for the organization’s final performance. Visit our website to learn more >>

Save the Date for the Gorman Health Group 2015 Forum. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor, MD. Learn more about the event >>