RT Journal Article
SR Electronic
T1 Medicare Advantage: Growth Amidst Mounting Scrutiny
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 1062
OP 1064
DO 10.3122/jabfm.2023.230111R1
VO 36
IS 6
A1 Adashi, Eli Y.
A1 O’Mahony, Daniel P.
A1 Cohen, I. Glenn
YR 2023
UL http://www.jabfm.org/content/36/6/1062.abstract
AB The Medicare Advantage Program, home to nearly half of the eligible Medicare population, has recently come under increased scrutiny. The Government Accountability Office called on the Centers for Medicare & Medicaid Services to monitor “disenrollment of MA beneficiaries in the last year of life, validate MA-provided encounter data, and strengthen audits used to identify and recover improper payments to MA plans.” The House Subcommittee on Oversight and Investigations of the Committee on Energy & Commerce, dedicated a hearing to “Protecting America’s Seniors: Oversight of Private Sector Medicare Advantage Plans.” In addition, a recently conducted audit of the Office of the Inspector General of the Department of Health and Human Services raised concerns over “denials of prior authorization requests” and “beneficiary access to medically necessary care.” In this article we consider the backdrop for the growing scrutiny of the MA program and the implications thereof to its future trajectory.