Medicare Advantage in the headlines: 7 recent updates

An insurer reached a nearly $100 million settlement over allegations of overpayments, and CMS plans to sunset a value-based model over "unprecedented" costs. 

Here are seven Medicare Advantage updates Becker's has reported since Dec. 10: 

1. UnitedHealth Group has optimized its ability to increase Medicare Advantage members' sickness scores and corresponding government payments by directly employing thousands of physicians at Optum and integrating sophisticated software tools into clinical workflows, according to an investigation from The Wall Street Journal.
   
2. Independent Health will pay up to $98 million to settle allegations a now-defunct subsidiary knowingly submitted invalid diagnoses to boost Medicare Advantage payments. 
   
   
3. New York City must pay for the cost of any plan it offers to its retired employees, the state's appeals court ruled, complicating its path to implementing a Medicare Advantage plan. 
   
   
4. CMS will sunset the Medicare Advantage Value-Based Insurance Design Model at the end of 2026, citing "unprecedented" costs to the Medicare trust fund. 
   
   
5. Sanford Health Plan and Lincoln, Neb.-based Bryan Health will launch a joint Medicare Advantage plan in 2026. Tommy Ibrahim, MD, CEO of Sanford Health Plan, told Becker's the insurer could pursue similar models in the future. 
   
   
6. HHS' Office of Inspector General issued a special fraud alert about the risks of fraud and abuse in certain marketing and compensation arrangements related to Medicare Advantage. 
   
   
7. A group of senators questioned prospective CMS administrator Mehmet Oz, MD, over his stance on Medicare Advantage and his financial ties to MA insurers. Led by Sen. Elizabeth Warren, seven Senate Democrats penned a letter to Dr. Oz, expressing concerns that Dr. Oz would push to eliminate traditional Medicare if confirmed as CMS administrator.