October 13, 2015

GAO Calls for More Federal Scrutiny of Network Adequacy in Medicare Advantage Plans

Congressional auditors at the Government Accountability Office (GAO) are calling for more federal oversight of the private health plans that participate in the Medicare Advantage program. As detailed in Kaiser Health News, the GAO investigation was spurred by instances in which health plans terminated contracts with doctors and facilities without notifying patients and in which patients received out-of-date provider directories. In response, the GAO has suggested the need for stronger oversight to assure that provider networks do not narrow to the point of falling below federal standards. Mike Adelberg, senior director for FaegreBD Consulting, noted that there are good business and patient-care reasons for health plans to narrow their provider networks, but also suggested the need for more transparency.

“Medicare Advantage plans are under the same pressure as all health plans to contain costs and to reward their highest value providers, and this probably is resulting in some network narrowing,” Adelberg said, adding that “consumers have a right to know what they are buying.”

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