Q&A: Executive shares how Medicare Advantage plans can survive, thrive amid regulatory scrutiny

DOJ
The Department of Justice has sent a clear signal to Medicare Advantage plans that it takes compliance seriously.

Editor's Note: The following is an excerpt from one of the stories in a special report about the recent RISE West Conference. Click to read the full version of this story and others in our Rise West Roundup report.

SCOTTSDALE, Ariz.—With Medicare Advantage growing ever more popular among seniors, there has scarcely been a better time for insurers to invest in this line of business.

But as health plans continue to innovate to better serve their MA members, they must remember to devote attention to an equally important effort: Compliance.

The two whistleblower lawsuits that the Department of Justice has joined against UnitedHealth are perhaps the most visible evidence of the increased scrutiny on MA plans’ risk adjustment practices—serving as a wake-up call for insurers to make sure they, too, don’t run afoul of regulators. (Editor's note: The DOJ dropped one of those cases this week after a judge dismissed the claims against UnitedHealth.)

But with the sheer complexity of running a Medicare Advantage or prescription drug plan (MA-PD), and what seems like constantly evolving regulations, that can be easier said than done. Few know that better than David Meyer, vice president of risk adjustment for SCAN Health Plan.

FierceHealthcare caught up with Meyer on Sept. 18 at the RISE West conference to discuss some of the key trends he’s seeing in risk adjustment compliance and how health plans can be prepared.

Click through to read the full Rise West Roundup report.

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