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Article CommentaryCommentary

Medicare Advantage: Growth Amidst Mounting Scrutiny

Eli Y. Adashi, Daniel P. O’Mahony and I. Glenn Cohen
The Journal of the American Board of Family Medicine November 2023, 36 (6) 1062-1064; DOI: https://doi.org/10.3122/jabfm.2023.230111R1
Eli Y. Adashi
From the Professor of Medical Science, Former Dean of Medicine and Biological Sciences, Brown University, Providence, RI (EYD); Director, Library Planning and Assessment, Brown University Library, Brown University, Providence, RI (DPO); Deputy Dean and James A. Attwood and Leslie Williams Professor of Law, Harvard Law School, Faculty Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA (IGC).
MD, MS
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Daniel P. O’Mahony
From the Professor of Medical Science, Former Dean of Medicine and Biological Sciences, Brown University, Providence, RI (EYD); Director, Library Planning and Assessment, Brown University Library, Brown University, Providence, RI (DPO); Deputy Dean and James A. Attwood and Leslie Williams Professor of Law, Harvard Law School, Faculty Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA (IGC).
MSLS
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I. Glenn Cohen
From the Professor of Medical Science, Former Dean of Medicine and Biological Sciences, Brown University, Providence, RI (EYD); Director, Library Planning and Assessment, Brown University Library, Brown University, Providence, RI (DPO); Deputy Dean and James A. Attwood and Leslie Williams Professor of Law, Harvard Law School, Faculty Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA (IGC).
JD
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References

  1. 1.↵
    The Commonwealth Fund, The evolution of private plans in Medicare. Published December 8, 2017. Available at: https://www.commonwealthfund.org/publications/issue-briefs/2017/dec/evolution-private-plans-medicare.
  2. 2.↵
    GAO. U.S. Government Accountability Office. Medicare advantage: continued monitoring and implementing Gao recommendations could improve oversight. Published June 28, 2022. Available at: https://www.gao.gov/products/gao-22-106026.
  3. 3.↵
    House Committee on Energy and Commerce. Hearing on “protecting America’s seniors: oversight of private sector Medicare advantage plans.” Published June 28, 2022. Available at: https://www.congress.gov/117/meeting/house/114959/documents/HHRG-117-IF02-Transcript-20220628.pdf.
  4. 4.↵
    U.S. Department of Health and Human Services. Office of Inspector General. Some Medicare Advantage organization denials of prior authorization requests raise concerns about beneficiary access to medically necessary care. Published April 27, 2022. Available at: https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp.
  5. 5.↵
    1. Freed M,
    2. Fuglesten Biniek J,
    3. Damico A,
    4. Neuman T
    . Medicare Advantage in 2022: enrollment update and key trends. Published August 25, 2022. Available at: https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/.
  6. 6.↵
    1. Xu L,
    2. et al
    . Issue brief: Medicare Advantage overview: a primer on enrollment and spending, HHS, ASPE, Office of Health Policy. Published May 25, 2023. Available at: https://aspe.hhs.gov/sites/default/files/documents/9b42ffbf2341726d5b63a9647b0aad15/medicare-advantage-overview.pdf.
  7. 7.↵
    Committee for a Responsible Federal Budget. File code CMS-4203-NC. Published August 31, 2022. Available at: https://www.crfb.org/papers/committee-sends-letter-cms-medicare-advantage.
  8. 8.↵
    U.S Department of Justice. Justice Department’s false claims act settlements and judgments exceed $5.6 billion in fiscal year 2021. Published February 1, 2022. Available at: https://www.justice.gov/opa/pr/justice-department-s-false-claims-act-settlements-and-judgments-exceed-56-billion-fiscal-year.
  9. 9.↵
    Letter to Secretary Becerra and CMS Administrator Brooks-LaSure. Published March 4, 2022. Available at: https://jayapal.house.gov/wp-content/uploads/2022/03/Medicare-Advantage-Rate-Notice-Comment_Final.pdf.
  10. 10.↵
    American Hospital Association. AHA calls for increased CMS oversight, DOJ action to hold Medicare Advantage plans accountable. Published May 19, 2022. Available at: https://www.aha.org/news/headline/2022-05-19-aha-calls-increased-cms-oversight-doj-action-hold-medicare-advantage-plans.
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The Journal of the American Board of Family     Medicine: 36 (6)
The Journal of the American Board of Family Medicine
Vol. 36, Issue 6
November-December 2023
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Medicare Advantage: Growth Amidst Mounting Scrutiny
Eli Y. Adashi, Daniel P. O’Mahony, I. Glenn Cohen
The Journal of the American Board of Family Medicine Nov 2023, 36 (6) 1062-1064; DOI: 10.3122/jabfm.2023.230111R1

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Medicare Advantage: Growth Amidst Mounting Scrutiny
Eli Y. Adashi, Daniel P. O’Mahony, I. Glenn Cohen
The Journal of the American Board of Family Medicine Nov 2023, 36 (6) 1062-1064; DOI: 10.3122/jabfm.2023.230111R1
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