By RaeAnn Grossman
We are hearing more about court cases and sanctions more than ever before in our industry. The Centers for Medicare and Medicaid Services (CMS) program audit always reviews a subset of contractual requirements every year and each year health plan executives are hit with surprising news. Executives not only want to know why and how issues occurred, but they want to know how they performed compared to others. Executives want to understand the cause, impact, and repercussions.
How much are we talking about?
- 37 sponsors were audited, who combined hold 115 contracts
- Approximately, $7.3 million in penalties were levied between October 2016 and March 1, 2017 that were non-risk adjustment related
- The 2016 average audit score was 1.22 which is a decrease from the 2015 average of 1.76 (scary!)
Sanctions do not just impact the pocketbook of a health plan, but can also impact open enrollment of a health plan. This was a significant issue for Cigna and its open enrollment for Medicare Advantage this year.
Listed under: ArroHealth