Lee Barrett

Program Audit season is over. Join our webinar to hear all about what CMS is focusing on. If you haven’t done a mock audit now is a great time to do one and incorporate our lessons learned.

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The whole notion of “public trust” has become an oxymoronic notion, at least when it comes to issues surrounding Connecticut’s health insurance exchange Access Health Connecticut. A recent audit discovers numerous failures in leadership, administration and accountability that puts the privacy of participants at risk. “The audit, which studied the Exchange between the years of 2020 and 2021, found that the Exchange suffered 51 data breaches of clients’ personal information, one of which exposed 160 clients’ information, and three of which they failed to disclose to the Auditors and State Comptroller. These breaches occurred both through the Exchange itself, as well as five of its contractors, one of which incurred 14 data breaches. The audit noted that the Exchange is statutorily required to notify both the Auditors and State Comptroller of any security breaches, to which the Exchange pleaded ignorance.” In addition: “The audit found no list of Navigator program employees, who have access to client’s personal information, that had completed criminal background checks.” Further: ““A lack of internal controls increases the risk that clients receive improper health insurance coverage or are enrolled in programs they are not eligible for,” read the audit.” The piece goes on to describe a lack of accountability for expenditures and ineligible employee credit card expenditures. This is shameful behavior that potentially puts vulnerable citizens at risk. Taxpayers deserve and demand better. #accountability #ConnecticutGovernment #healthcare

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Major Changes Coming For The KC Market 📢 Blue KC to Exit Medicare Advantage Market by 2025 Due to Regulatory Demands 📢 Blue Cross and Blue Shield of Kansas City (Blue KC) has announced its departure from the Medicare Advantage (MA) market by the end of 2024, citing increased regulatory demands and financial pressures as primary reasons for the decision. The company will shift its focus to employer-sponsored health plans, Medicare supplement plans, and Affordable Care Act plans while ensuring uninterrupted, quality service to current MA members through 2024. With a smaller MA membership base, Blue KC finds it challenging to compete economically at scale, leading to the difficult but necessary market exit. In a statement, Blue KC's President and CEO, Erin Stucky, expressed disappointment, saying, “We explored every alternative path for our MA members and are disappointed we must exit this line of business.” This move aligns with industry trends, as other insurers, like Oscar Health, have also exited the MA market due to similar challenges, including the impact of regulatory changes such as the CMS's benchmark payment adjustments on the profitability of MA plans for smaller insurers. #Healthcare #MedicareAdvantage #BlueKC #RegulatoryChallenges #InsuranceIndustry #HealthPlans #CMS #MarketExit

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Medicare Advantage unrest, Change Healthcare fallout and more big takeaways from insurers’ Q1 https://lnkd.in/eyg48k7e via Healthcare Dive #MedicareAdvantage #ChangeHealthcare #Cybersecurity #CMS #Medicaid

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Join me at our live webinar on May 15 to learn more about the newly defined standard Part D benefit. 

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Cigna Group allegedly exaggerated the health conditions of its enrollees to fraudulently obtain hundred of millions in federal funds. Read more: https://direc.to/fhHz Cigna Group significantly impacts healthcare today by expanding its pharmacy and medical customer base, as evidenced by a 25% increase in pharmacy customers and a growth in medical customers. Additionally, Cigna's involvement in healthcare trends and innovations, such as the Better Care Bulletin, showcases its role in improving health outcomes and integrating technology in healthcare. The HHS Office of Inspector General (HSS-OIG) combats healthcare fraud through rigorous oversight, investigations, and audits. It collaborates with the Department of Justice (DOJ) to enforce laws and impose penalties on fraudulent activities, as seen in actions against the Center for Medicare and Medicaid Services (CMS) fraud. #unitedseniorassociation #USA #eldercare #FDA #seniorliving #ADA #AI #NIH #patientcare #compliance #hospitals #OIG #healthcare #HHSOIG #digitalhealth #HSS #CMS #assistedliving #nursinghomes #seniorcare #medicare #seniorcitizen #homehealthcare #caregiver #dementia #inhomecare #seniorhealth #kloekorby #alzheimers #mentalhealth

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