Anthem Blue Cross is a Medicare Advantage Organization
with a Medicare contract.
* A Medicare Advantage organization
cannot offer cash or other monetary rebates as an inducement for enrollment or otherwise.
(6) Refers to a contract between a Medicare Advantage organization
(typically an insurer) and CMS to enroll Medicare beneficiaries and provide them services in a defined geographic area.
DaVita voluntarily disclosed to the government various practices that were instituted by HealthCare Partners, a California-based independent physician association that DaVita acquired in 2012, that caused Medicare Advantage Organizations
to submit incorrect diagnosis codes to CMS and obtain inflated payments in which DaVita and HealthCare Partners shared, the Department of Justice said in a statement.
Sean Cavanaugh, director of the Center for Medicare, an arm of the Centers for Medicare & Medicaid Services, gave the figures in a memo addressed to Medicare Advantage organizations
and Medicare prescription drug plan sponsors.
The money, paid out as part of the Medicare and Medicaid Electronic Health Records Incentive Programs, went to physicians and other providers, hospitals, and Medicare Advantage organizations
starting in 2011.
The regulations also would require Medicare Advantage organizations
to establish commission structures for sales agents and brokers that are level across all years and across all product types.
Medicare Advantage organizations
that use independent agents to market would be required to use state-licensed agents and to report to states that they were using those agents.
According to our analysis, CMS did not meet the requirement for auditing the financial records of at least one-third of the participating Medicare Advantage organizations
for contract years 2001-2005.
"These standards will allow Medicare, physicians, hospitals, group practices, other health providers, and prescription drug plan sponsors and Medicare Advantage organizations
to take advantage of e-prescribing technology to improve medication prescribing for Medicare beneficiaries that participate in the new prescription drug program," said Mike Leavitt secretary of the Department of Health and Human Services.