Is the Honeymoon Over for Medicare Advantage?

Last week was a bad week for Medicare Advantage plans:

· Overpayment allegation: Monday, a New York district judge handed down a ruling unfavorable to Anthem related to its defense against charges of overbilling vis a vis its risk adjustment practices (aka RADV audits). The Justice Department is using its False Claims authority to pursue Anthem’s business practice and recover more than $600 million in Medicare overpayment dating back to 2011. And the DOJ is proposing a change to how audits are conducted by removing Medicare Advantage insurers’ “fee-for-service adjuster.” comparison to traditional Medicare that could reduce the per enrollee monthly payment from Medicare to plans. The implication is that alleged Medicare overpayments...