January 07, 2021

Mike Adelberg Shares 2021 Outlook on Medicare Advantage Program Enforcement With AIS Health

In a Q&A with AIS Health for the RADAR on Medicare Advantage publication, Faegre Drinker Consulting Principal Mike Adelberg shared his 2021 outlook for Medicare Advantage (MA) program enforcement under the incoming Biden administration, explaining how doing business may look different than in previous years.

In response to the question, “What do you think we can expect in terms of program enforcement?” Adelberg said, “The last time a Democrat administration replaced a Republican, there was a significant ramp-up of MA plan oversight activities.” According to Adelberg, while “2021 is not 2009, MA is a more mature program and plan conduct is better than it was in 2009.”

However, Adelberg stated that he would “still look for a Biden-run Centers for Medicare and Medicaid Services (CMS) to tighten its oversight MA processes in select areas.” He added, “Risk adjustment, provider networks, and marketing are good bets.”

The full article is available for RADAR on Medicare Advantage subscribers.

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