Health Law Highlights

HHS OIG Introduces Managed Care Strategic Plan

From Squire Patton Boggs, by Bevan Blake:

  • In response to the continued growth of managed care in government-sponsored health plans over the last several years, the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services (“HHS”) introduced a new “Strategic Plan for Oversight of Managed Care for Medicare and Medicaid.”
    • A majority of Medicare beneficiaries are enrolled in a Medicare Advantage Plan.
    • It is estimated that the share of beneficiaries enrolled in Medicare Advantage Plans will increase to 60% in ten years.
    • For Medicaid, almost seventy-five percent (75%) of beneficiaries are now enrolled with comprehensive Managed Care Organizations.
  • The Strategic Plan identifies three areas of focus for OIG: (1) promoting access to care for enrollees, (2) providing comprehensive financial oversight, and (3) promoting data accuracy.
  • Promoting Access to Care: OIG will review plans and assess whether they meet network adequacy standards.
  • Financial Oversight: OIG will work with managed care plans to identify and prevent fraud within the plans and to ensure the accuracy of the risk-adjusted capitated payments provided to managed care plans.
  • Data Accuracy: OIG wants provider identifiers on Medicare Advantage encounter data so it can provide oversight of the program, and avoid losses caused by enrollees who are enrolled in two different states or managed care organizations.